PT  - JOURNAL ARTICLE
AU  - Panni, Pietro
AU  - Michelozzi, Caterina
AU  - Richard, Sébastien
AU  - Marnat, Gaultier
AU  - Blanc, Raphaël
AU  - Consoli, Arturo
AU  - Mazighi, Mikael
AU  - Piotin, Michel
AU  - Dargazanli, Cyril
AU  - Arquizane, Caroline
AU  - Sibon, Igor
AU  - Anxionnat, René
AU  - Hossu, Gabriela
AU  - Bourcier, Romain
AU  - Anadani, Mohammad
AU  - Lapergue, Bertrand
AU  - Gory, Benjamin
TI  - Effect of workflow metrics on clinical outcomes of low diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) patients subjected to mechanical thrombectomy
AID  - 10.1136/neurintsurg-2019-015519
DP  - 2020 Aug 01
TA  - Journal of NeuroInterventional Surgery
PG  - 742--746
VI  - 12
IP  - 8
4099  - http://jnis.bmj.com/content/12/8/742.short
4100  - http://jnis.bmj.com/content/12/8/742.full
SO  - J NeuroIntervent Surg2020 Aug 01; 12
AB  - Background Although accumulating evidence has demonstrated the benefit of mechanical thrombectomy (MT) in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), it is still unclear how workflow metrics impact the clinical outcomes of this subgroup of patients.Methods Patients with acute stroke and diffusion-weighted imaging (DWI) ASPECTS ≤5 at baseline, who underwent MT within 6 hours of symptoms onset, were included from a prospectively maintained national multicentric registry between January 1, 2012 to August 31, 2017. The degree of disability was assessed by the modified Rankin Scale (mRS) at 90 days. The primary outcome was functional independence defined as mRS 0 to 2 at 90 days.Results The study included 291 patients with baseline DWI-ASPECTS ≤5. Good outcome was achieved in 82 (28.2%) patients, and 104 (35.7%) patients died within 90 days. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) rate was 75.3%, and median onset to recanalization (OTR) time was 2 268min. Among time-related variables, OTR emerged as the strongest predictor of primary outcome (adjusted OR for every 60 min 0.59, 95% CI 0.44 to 0.77; p<0.001). mTICI 2c-3 independently predicted a good outcome (adjusted OR 1.91, 95% CI 1.004 to 3.6; p=0.049) along with age and baseline DWI-ASPECTS. Recanalization status failed to significantly impact outcome in the DWI-ASPECTS 0–3 subpopulation.Conclusions Near complete reperfusion (mTICI 2c-3) and OTR are the strongest modifiable outcome predictors in patients with DWI-ASPECTS ≤5 treated with MT.