- Title
- Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core.
- Creator
- Garcia-Esperon, Carlos; Bivard, Andrew; Dong, Qiang; Aviv, Richard I.; Miteff, F; Spratt, NJ; Levi, CR; Parsons, MW; INSPIRE Study group,; Johns, Hannah; Chen, Chushuang; Churilov, Leonid; Lin, Longting; Butcher, Kenneth; Kleinig, Timothy J.; Choi, Philip M. C.; Cheng, Xin
- Relation
- Neurology Vol. 99, Issue 13, p. E1345-E1355
- Publisher Link
- http://dx.doi.org/10.1212/WNL.0000000000200908
- Publisher
- Wolters Kluwer Health
- Resource Type
- journal article
- Date
- 2022
- Description
- BACKGROUNDS AND OBJECTIVES: Endovascular thrombectomy (EVT) is effective for large vessel occlusion (LVO) stroke patients with smaller volumes of computed tomography perfusion (CTP)-defined ischemic core. However, the benefit of EVT is unclear in those with a core>70mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core≥70mL, hypothesizing that there would be a benefit from EVT for fair outcome (three-month modified Rankin Scale, mRS, 0-3) after stroke. METHODS: Retrospective analysis of patients enrolled into a multi-center (Australia, China and Canada) registry (2012-2020) who underwent CTP within 24 hours of stroke onset and had a baseline ischemic core≥70mL. Primary outcome was the estimation of the association of EVT in patients with core volume ≥70mL, as well as within 70-100mL and ≥100mL subgroups with fair outcome. RESULTS: Of the 3283 patients in the registry, 299 had CTP core≥70 mL and 269 complete data (135 had core volume between 70-100mL and 134≥100mL). EVT was performed in 121(45%) patients. EVT-treated patients were younger (median 69 versus 75 years; p=0.011), had lower pre-stroke mRS, and smaller median core volumes, 92[79-116.5]mL versus 105.5[85.75-138]mL, (p=0.004). EVT-treated patients had higher odds of achieving fair outcome in adjusted analysis (30% versus 13.9% in the non-EVT group; aOR 2.1(95% CI 1, 4.2), p=0.038). The benefit was seen predominantly in those with 70-100mL core (71 /135 (52.6%) EVT-treated), with 54.3% in EVT-treated versus 21% in non-EVT group achieving a fair outcome (aOR 2.5 (95% CI 1, 6.2), p=0.005). Of those with a core≥100mL, 50 /134(37.3%) underwent EVT. Proportions of fair outcome were very low in both groups (8.1% versus 8.7%; p=0.908). DISCUSSION: We found a positive association of EVT with 3-month outcome after stroke in patients with a baseline CTP ischemic core volume 70-100 mL but not in those with ≥100 mL. Randomized data to confirm these findings is required. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that EVT is associated with better motor outcomes 3 months following CTP-defined ischemic stroke with core of 70-100 mL.
- Subject
- patients; stroke; thrombectomy; ischemic core
- Identifier
- http://hdl.handle.net/1959.13/1465642
- Identifier
- uon:47319
- Identifier
- ISSN:0028-3878
- Language
- eng
- Reviewed
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