Identifying large ischemic core volume ranges in acute stroke that can benefit from mechanical thrombectomy

Abstract

BackgroundWe aimed to identify the large ischemic core (LIC) volume ranges in acute ischemic stroke patients that can benefit from mechanical thrombectomy (MT).MethodsConsecutive patients within 24 hours of onset of anterior circulation ischemic stroke with large vessel occlusion and ischemic core volumes of 70–300 mL were included from our single-center prospective database from March 2014 to December 2019. Subjects were divided into three groups by baseline ischemic core volume (A: 70–100 mL; B: 101–130 mL; C: >130 mL). We compared modified Rankin Scale (mRS) score 0–2 at 3 months and parenchymal hematoma between patients receiving MT and standard medical treatment (SMT), and determined clinically treatable core volume ranges for MT.ResultsOf 157 patients (86 women; median age, 81 years; median ischemic core volume, 123 mL), 49 patients underwent MT. In Group A (n=52), MT patients (n=31) showed a higher proportion of mRS 0–2 at 3 months (52% vs 5%, P<0.05) versus SMT, respectively. Group B (n=36) MT patients (n=14) also had a higher proportion of mRS 0–2 at 3 months (29% vs 9%, P=0.13) versus SMT, respectively. In Group C (n=69), only four patients received MT. The 95% confidence intervals for the probability of mRS 0–2 at 3 months in patients with MT (n=49) versus SMT (n=108) intersected at 120–130 mL.ConclusionsIschemic core volumes between 70 and 100 mL may benefit from MT. The treatable upper core limit is approximately 120 mL in selected patients with LIC of 70–300 mL.

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

“…Six patients (40%) were female; the median (IQR) age was 80 (75-83) years; the median NIHSS score was 18 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25); baseline ASPECTS on DWI or CT: 7 (6-10); onset-to-groin puncture time: 141 (101-170) min. The median groin punctureto-revascularization time was 55 (45-75) min, of which the median groin puncture-to-revascularization time in isolated M2 occlusion was 35 (27-41) min, and that for tandem occlusion or multi-vessel M2 occlusion was 82 (58-112) min.…”

“…All AIS patients admitted to our institute within 7 days from symptom onset or last-known-well date were prospectively registered in the National Cerebral and Cardiovascular Center (NCVC) Stroke Registry (8)(9)(10)(11)(12)(13). Data for AIS patients with MCA M2 occlusion undergoing the BEMP technique were collected retrospectively from the NCVC Stroke Registry from March 2019 to June 2020.…”

Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis

“…Amongst 622 studies screened for inclusion and two records yielded from other sources between 2015 and June 2020, a total of 10 records 3,6,8,[15][16][17][18][19][20][21] with 954 patients with baseline large ischemic volumes were included in our review. See flowchart of studies selection in Figure 1.…”

“…Five studies (71.5%) were from a single center, and six (85.7%) reported a prospective enrolment. Amongst the included studies, six 3,8,16,[19][20][21] totalizing 682 patients had control groups treated with BMT alone, allowing to compare 332 patients who received MT to 350 who received BMT only. Four studies 3,6,15,18 used only MRI, two 8,20 over 90% of MRI and were merged with the MRI group.…”

RNF213 p.R4810K (c.14429G > A) Variant Determines Anatomical Variations of the Circle of Willis in Cerebrovascular Disease

“…All patients with ischemic stroke or transient ischemic attack (TIA) who were admitted to our institute within 7 days of symptom onset or last-known-well were prospectively registered to the NCVC Stroke Registry (Yoshimoto et al, 2021). Data for the period from January 2011 to July 2019 were retrospectively reviewed, and patients who met the following criteria were included: ( 1…”