Combined Multimodal Computed Tomography Score Correlates With Futile Recanalization After Thrombectomy in Patients With Acute Stroke

Abstract

Background and Purpose-Futile recanalization after acute ischemic stroke occurs in almost half of the patients despite optimal angiographic results. Multimodal neuroimaging may help to improve patient's selection but is still dismissed by many interventionalists. Our aim was to evaluate the accuracy of each parameter of multimodal computed tomography (CT) and their combination for predicting futile recanalization after successful thrombectomy. Methods-We retrospectively reviewed a cohort of consecutive patients with anterior circulation stroke, fully assessable multimodal CT, and successful recanalization. Nonenhanced CT, CT angiography source images, cerebral blood volume (CBV), cerebral blood flow (CBF), and mismatch CBV-CBF maps were studied by Alberta Stroke Program Early CT Score (ASPECTS); collaterals on CT angiography were graded as poor or good (≤50% or >50% of the middle cerebral artery territory). Futile recanalization was defined as modified Rankin Scale score >2 at 3 months despite successful recanalization. Results-One hundred fifty patients were included and 57% of them had futile recanalization. They had lower ASPECTS on nonenhanced CT, CT angiography source images, CBV, CBF, and mismatch CBV-CBF and presented more frequently poor collaterals (all P<0.001). Among them, CBV showed the highest area under the curve (0.83; 95% confidence interval, 0.76-0.88). In multivariate analyses, CT angiography source images ≤5 (odds ratio, 5.1; 95% confidence interval, 1.2-21.9), CBV≤6 (odds ratio, 3.5; 95% confidence interval, 1.2-9.7), and poor collaterals (odds ratio, 8.6; 95% confidence interval, 1.8-41.7) were independent predictors of futile recanalization. A combined score of these 3 parameters added complementary information: 57% of the patients with score-1, 89% with score-2, and 100% with score-3 had futile recanalization. Reclassification analyses indicated that this score improved prediction of futile recanalization. Conclusions-In this population, a combined multimodal CT score predicted futile recanalization.

Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemic stroke by promoting anterograde reperfusion and retrograde collateral flow

“…In our study, 10 patients responded with successful recanalization after fingolimod treatment, and 8 (80%) patients experienced good outcomes, which is higher when compared with the alteplase alone group (30%) or in other studies evaluating pharmacologic or mechanical recanalization (50%) 2. This result suggests that fingolimod relieved futile recanalization in patients with causative clot dissolution.…”

Alberta Stroke Program Early CT Score in the Prognostication after Endovascular Treatment for Ischemic Stroke: A Meta-analysis

“…Of these, 13 studies were pertinent to include in this review [34511121318192021222324]. A flow diagram summarizing the literature search is presented in Figure 1.…”

“…To our knowledge, although ASPECTS was originally designed for use with IVT, recent studies indicated its practicability for use with endovascular treatment [111213]. However, previous studies in smaller cohorts are insuff icient to clarify the predictability of baseline ASPECTS in endovascular therapy.…”

Shear-Activated Nanoparticle Aggregates Combined With Temporary Endovascular Bypass to Treat Large Vessel Occlusion

“…Possible explanations for futile recanalization 8,9 include delayed recanalization of completed infarcts, small infarcts in eloquent brain regions, and unfavorable post-treatment events, such as rare reocclusion 10,11 or reperfusion injury that despite extensive preclinical data still requires validation in clinical cohorts (reviewed in Lo et al 12 and Eltzschig and Eckle 13 ). In fact, both local vessel wall injury and focal vessel wall inflammation with possible distal (brain parenchyma) effects may occur after thrombectomy.…”

“…If there was no change after treatment with persistent complete vessel occlusion and no antegrade flow of contrast, 0 points were assigned (rmTICI 0). (5), buccal artery (6), mandibular alveolar artery (7), lower labial artery (8), distal part of facial artery (9), transversal facial artery (10), auricular artery (11) …”