PT - JOURNAL ARTICLE AU - Deb-Chatterji, Milani AU - Pinnschmidt, Hans AU - Flottmann, Fabian AU - Leischner, Hannes AU - Broocks, Gabriel AU - Alegiani, Anna AU - Brekenfeld, C AU - Fiehler, Jens AU - Gerloff, Christian AU - Thomalla, Goetz ED - TI - Predictors of independent outcome of thrombectomy in stroke patients with large baseline infarcts in clinical practice: a multicenter analysis AID - 10.1136/neurintsurg-2019-015641 DP - 2020 Nov 01 TA - Journal of NeuroInterventional Surgery PG - 1064--1068 VI - 12 IP - 11 4099 - http://jnis.bmj.com/content/12/11/1064.short 4100 - http://jnis.bmj.com/content/12/11/1064.full SO - J NeuroIntervent Surg2020 Nov 01; 12 AB - Objective To analyze outcome and its predictors after endovascular treatment (ET) in stroke patients suffering from large vessel occlusion with large pre-treatment infarct cores defined by an Alberta Stroke Program Early CT Score (ASPECTS) <6.Methods We analyzed data from an industry-independent, multicenter, prospective registry (German Stroke Registry – Endovascular Treatment) which enrolled consecutive patients treated by ET (June 2015–April 2018) with different devices. Multivariate logistic regression analyses identified predictors of independent outcome (IO) defined as a modified Rankin Scale (mRS) 0–2, and mortality at 90 days in patients with ASPECTS <6.Results Of 1700 patients included in the analysis, 152 (8.9%) had a baseline ASPECTS <6. Of these, 33 patients (21.6%) achieved IO, and 68 (44.7%) were dead at 90 days. A lower age, lower baseline National Institutes of Health Stroke Scale (NIHSS) score, and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) were predictors of IO. Successful recanalization had the strongest association with IO (OR 7.0, 95% CI 1.8 to 26.8). Pre-treatment parameters predicting IO were age <70 years (sensitivity 0.79, specificity 0.69) and NIHSS <12 (0.57 and 0.94). A higher age, a pre-stroke mRS score >1, and failed recanalization were predictors of death.Conclusions A substantial proportion of stroke patients with an ASPECTS <6 can achieve independence after thrombectomy, in particular, if they are younger, have only moderate baseline stroke symptoms, and no relevant pre-stroke disability. These results may encourage considering thrombectomy in low ASPECTS patients in clinical practice until randomized trials are available.