Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core

Eyad Almallouhi, Sara Zandpazandi, Mohammad Anadani, Conor Cunningham, Mohammad Mahdi Sowlat, Hidetoshi Matsukawa, Atakan Orscelik, Sameh Samir Elawady, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Edgar A. Samaniego, Adam S. Arthur, Shinichi Yoshimura, Hugo CuellarJonathan A. Grossberg, Ali Alawieh, Daniele G. Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam J. Polifka, Joshua W. Osbun, Roberto Javier Crosa, Charles Matouk, Min S. Park, Michael R. Levitt, Waleed Brinjikji, Mark Moss, Travis M. Dumont, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel A. Chowdhry, Mohamad Ezzeldin, Alejandro M. Spiotta

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2). Methods: Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. Results: We identified 58 patients who presented with ASPECTS 0-2 and underwent MT. Median age was 70.0 (59.0-78.0) years, 45.1% were females, and 202 (36.3%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 268 (54.6%) patients and stent retriever was used in 70 (14.3%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 4.5%, 27.9% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. Conclusions: This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.

Original languageEnglish
Article number021046
JournalJournal of NeuroInterventional Surgery
DOIs
StateAccepted/In press - 2023

Keywords

  • Intervention
  • Intracranial Thrombosis
  • Stenosis
  • Stroke
  • Thrombectomy

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