RT Journal Article
SR Electronic
T1 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
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 742
OP 746
DO 10.1136/neurintsurg-2019-015519
VO 12
IS 8
A1 Panni, Pietro
A1 Michelozzi, Caterina
A1 Richard, Sébastien
A1 Marnat, Gaultier
A1 Blanc, Raphaël
A1 Consoli, Arturo
A1 Mazighi, Mikael
A1 Piotin, Michel
A1 Dargazanli, Cyril
A1 Arquizane, Caroline
A1 Sibon, Igor
A1 Anxionnat, René
A1 Hossu, Gabriela
A1 Bourcier, Romain
A1 Anadani, Mohammad
A1 Lapergue, Bertrand
A1 Gory, Benjamin
YR 2020
UL http://jnis.bmj.com/content/12/8/742.abstract
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.