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Exploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis

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dc.contributor.authorChen, C.
dc.contributor.authorParsons, M.W.
dc.contributor.authorLevi, C.R.
dc.contributor.authorSpratt, N.J.
dc.contributor.authorMiteff, F.
dc.contributor.authorLin, L.
dc.contributor.authorCheng, X.
dc.contributor.authorLou, M.
dc.contributor.authorKleinig, T.
dc.contributor.authorButcher, K.
dc.contributor.authorDong, Q.
dc.contributor.authorBivard, A.
dc.date.issued2019
dc.description.abstractOBJECTIVE:To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). METHODS:EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic core and penumbral volumes. RESULTS:From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core <30 mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0-1 odds ratio 0.01, p < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals (p = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0-1 odds ratio 1.61, p < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, p = 0.008). CONCLUSION:From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.
dc.description.statementofresponsibilityChushuang Chen, Mark W. Parsons, Christopher R. Levi, Neil J. Spratt, Ferdinand Miteff, Longting Lin ... et al.
dc.identifier.citationNeurology, 2019; 93(3):E283-E292
dc.identifier.doi10.1212/WNL.0000000000007768
dc.identifier.issn0028-3878
dc.identifier.issn1526-632X
dc.identifier.orcidKleinig, T. [0000-0003-4430-3276]
dc.identifier.urihttps://hdl.handle.net/2440/132052
dc.language.isoen
dc.publisherAAN Publications
dc.rights© 2019 American Academy of Neurology
dc.source.urihttps://doi.org/10.1212/wnl.0000000000007768
dc.subjectHumans
dc.subjectInfarction, Middle Cerebral Artery
dc.subjectIntracranial Hemorrhages
dc.subjectPrognosis
dc.subjectThrombolytic Therapy
dc.subjectThrombectomy
dc.subjectCohort Studies
dc.subjectCerebrovascular Circulation
dc.subjectCollateral Circulation
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectStroke
dc.subjectEndovascular Procedures
dc.subject.meshHumans
dc.subject.meshInfarction, Middle Cerebral Artery
dc.subject.meshIntracranial Hemorrhages
dc.subject.meshPrognosis
dc.subject.meshThrombolytic Therapy
dc.subject.meshThrombectomy
dc.subject.meshCohort Studies
dc.subject.meshCerebrovascular Circulation
dc.subject.meshCollateral Circulation
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshStroke
dc.subject.meshEndovascular Procedures
dc.titleExploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis
dc.typeJournal article
pubs.publication-statusPublished

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