Large Infarct Volume Post Thrombectomy: Characteristics, Outcomes, and Predictors

Daniel A Tonetti; Shashvat M Desai; Joseph Hudson; Bradley A Gross; Ruchira M Jha; Bradley J Molyneaux; Brian T Jankowitz; Tudor G Jovin; Ashutosh P Jadhav

doi:10.1016/j.wneu.2020.04.139

Large Infarct Volume Post Thrombectomy: Characteristics, Outcomes, and Predictors

World Neurosurg. 2020 Jul:139:e748-e753. doi: 10.1016/j.wneu.2020.04.139. Epub 2020 Apr 27.

Authors

Daniel A Tonetti¹, Shashvat M Desai², Joseph Hudson³, Bradley A Gross¹, Ruchira M Jha², Bradley J Molyneaux², Brian T Jankowitz⁴, Tudor G Jovin⁴, Ashutosh P Jadhav⁵

Affiliations

¹ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
² Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
³ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁴ Cooper Neurological Institute, Cooper University Medical Center, Camden, New Jersey, USA.
⁵ Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: jadhav.library@gmail.com.

PMID: 32353539
DOI: 10.1016/j.wneu.2020.04.139

Abstract

Background: Despite increasing interest in endovascular therapy (EVT) for large-core strokes, little is known about the predictors of good outcome in these patients. The aim of this study was to analyze patients with large-core strokes post-EVT and to define the predictors of favorable outcome in this population.

Methods: A retrospective analysis of prospectively collected data on anterior circulation strokes undergoing EVT between January 2015 and February 2018 was performed. Patients with good baseline functional status who underwent EVT for occlusion of an anterior circulation artery and achieved successful recanalization (modified Treatment in Cerebral Ischemia score ≥2b) but had large follow-up infarct volume (FIV ≥70 cm³) were included in the study. Demographic characteristics, clinical and radiologic data, treatment and postprocedural outcomes were extracted and analyzed. The primary outcome was 90-day modified Rankin Scale (mRS) score, stratified by favorable (mRS 0-3) versus unfavorable (mRS 4-6).

Results: Of 355 patients meeting inclusion criteria, 85 (24%) had large FIV on follow-up imaging after EVT and constituted the study cohort. No patients achieved mRS score 0-2 at hospital discharge; 32% had 90-day mRS score 0-3. On multivariate logistic regression analysis, lower FIV (OR, -0.96 [0.95-0.99]; P = 0.007), male sex (OR, -1.29 [1.07-12.3]; P = 0.026), and intravenous tissue plasminogen activator use (OR, 3.6 [2.01-8.9]; P = 0.003) were independent predictors of favorable outcome. Independent predictors of mortality on multivariate analysis were higher FIV (OR, -1.01 [1.007-1.02]; P = 0.001) and female sex (OR, 4.08 [1.25-13.3]; P = 0.02).

Conclusions: For patients with large-core strokes (≥70 cm³) after EVT, approximately one third have favorable outcome at 90 days. Independent predictors of favorable 90-day outcomes include male sex, intravenous tissue plasminogen activator use, and lower FIV.

Keywords: Acute ischemic stroke; Large core; Large vessel occlusion; Mechanical thrombectomy.

MeSH terms

Aged
Cerebral Infarction / pathology
Female
Humans
Male
Middle Aged
Recovery of Function*
Retrospective Studies
Stroke / pathology*
Stroke / surgery*
Thrombectomy / methods*