TY - JOUR
T1 - Baseline clinical and neuroradiological predictors of outcome in patients with large ischemic core undergoing mechanical thrombectomy: a retrospective multicenter study
AU - Alexandre, Andrea
AU - Monforte, Mauro
AU - Brunetti, Valerio
AU - Scarcia, Luca
AU - Cirillo, Luigi
AU - Zini, Andrea
AU - Scala, Irene
AU - Nardelli, Vincenzo
AU - Arbia, Francesco
AU - Arbia, Giuseppe
AU - Frisullo, Giovanni
AU - Kalsoum, Erwah
AU - Camilli, Arianna
AU - De Leoni, Davide
AU - Francesca, Colò
AU - Abruzzese, Serena
AU - Piano, Mariangela
AU - Rollo, Claudia
AU - Macera, Antonio
AU - Ruggiero, Maria
AU - Lafe, Elvis
AU - Gabrieli, Joseph Domenico
AU - Cester, Giacomo
AU - Limbucci, Nicola
AU - Arba, Francesco
AU - Ferretti, Simone
AU - Da Ros, Valerio
AU - Bellini, Luigi
AU - Salsano, Giancarlo
AU - Mavilio, Nicola
AU - Russo, Riccardo
AU - Bergui, Mauro
AU - Caragliano, Antonio Armando
AU - Vinci, Sergio Lucio
AU - Romano, Daniele Giuseppe
AU - Frauenfelder, Giulia
AU - Semeraro, Vittorio
AU - Porzia, Ganimede Maria
AU - Lozupone, Emilio
AU - Romi, Andrea
AU - Cavallini, Anna
AU - Milonia, Luca
AU - Muto, Massimo
AU - Candelaresi, Paolo
AU - Calabresi, Paolo
AU - Pedicelli, Alessandro
AU - Broccolini, Aldobrando
PY - 2024
Y1 - 2024
N2 - Background: Recent randomized trials have shown the benefit of mechanical thrombectomy (MT) also in patients with an established large ischemic core. Aim: The purpose of this study was to define baseline predictors of clinical outcome in patients with large vessel occlusion (LVO) in the anterior circulation and an Alberta Stroke Program Early CT score (ASPECTS) ≤ 5, undergoing MT. Material and methods: The databases of 16 comprehensive stroke centers were retrospectively screened for patients with LVO and ASPECTS ≤ 5 that received MT. Baseline clinical and neuroradiological features, including the differential contribution of all ASPECTS regions to the composite score, were collected. Primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2. Statistical analysis used a logistic regression model and random forest algorithm. Results: 408 patients were available for analysis. In multivariate model, among baseline features, lower age (OR 0.962, 95% CI 0.943-0.982) and lower National Institute of Health Stroke Scale (NIHSS) score (OR 0.911, 95% CI 0.862-0.963) were associated with the mRS score 0-2. Involvement of the M2 (OR 0.398, 95% CI 0.206-0.770) or M4 (OR 0.496, 95% CI 0.260-0.945) ASPECTS regions was associated with an unfavorable outcome. Random forest analysis confirmed that age and baseline NIHSS score are the most important variables influencing clinical outcome, whereas involvement of cortical regions M5, M4, M2 and M1 can have a negative impact. Conclusion: Our retrospective analysis shows that, along with age and baseline clinical impairment, presence of early ischemic changes involving cortical areas has a role in clinical outcome in patients with large ischemic core undergoing MT.
AB - Background: Recent randomized trials have shown the benefit of mechanical thrombectomy (MT) also in patients with an established large ischemic core. Aim: The purpose of this study was to define baseline predictors of clinical outcome in patients with large vessel occlusion (LVO) in the anterior circulation and an Alberta Stroke Program Early CT score (ASPECTS) ≤ 5, undergoing MT. Material and methods: The databases of 16 comprehensive stroke centers were retrospectively screened for patients with LVO and ASPECTS ≤ 5 that received MT. Baseline clinical and neuroradiological features, including the differential contribution of all ASPECTS regions to the composite score, were collected. Primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2. Statistical analysis used a logistic regression model and random forest algorithm. Results: 408 patients were available for analysis. In multivariate model, among baseline features, lower age (OR 0.962, 95% CI 0.943-0.982) and lower National Institute of Health Stroke Scale (NIHSS) score (OR 0.911, 95% CI 0.862-0.963) were associated with the mRS score 0-2. Involvement of the M2 (OR 0.398, 95% CI 0.206-0.770) or M4 (OR 0.496, 95% CI 0.260-0.945) ASPECTS regions was associated with an unfavorable outcome. Random forest analysis confirmed that age and baseline NIHSS score are the most important variables influencing clinical outcome, whereas involvement of cortical regions M5, M4, M2 and M1 can have a negative impact. Conclusion: Our retrospective analysis shows that, along with age and baseline clinical impairment, presence of early ischemic changes involving cortical areas has a role in clinical outcome in patients with large ischemic core undergoing MT.
KW - ASPECT
KW - Acute stroke therapy
KW - clinical outcome
KW - large ischemic core
KW - large vessel occlusion
KW - mechanical thrombectomy
KW - ASPECT
KW - Acute stroke therapy
KW - clinical outcome
KW - large ischemic core
KW - large vessel occlusion
KW - mechanical thrombectomy
UR - https://publicatt.unicatt.it/handle/10807/269899
U2 - 10.1177/17474930241245828
DO - 10.1177/17474930241245828
M3 - Article
SN - 1747-4930
SP - N/A-N/A
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - March
ER -