Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures

Ribó, Marc; Lemus, Miguel; Rubiera, Marta; Vert, Carla; Flores, Alan; Coscojuela, Pilar; Pagola, Jorge; Rodríguez‐Luna, David; Bonet, Sandra; Muchada, Marián; Molina, Carlos A.

doi:10.1161/strokeaha.115.010707

Cited by 34 publications

(33 citation statements)

References 18 publications

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“…10 Similarly, Ribo et al found that only 12% of patients with infarct core >39 mL achieved favorable outcome after EVT despite recanalization. 32 Importantly, however, in the above mentioned 3 studies, 10,31,32 most patients were treated well beyond the 4.5-hour time point. This likely explains the discrepant findings between those studies supporting a core cut point to identify a futile group and the remaining cited studies, [16][17][18][19] including ours.…”

Section: Discussionmentioning

confidence: 95%

Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization?

Tisserand

Turc

Charron

et al. 2016

Stroke

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Background and Purpose-Whether to withhold recanalization treatment when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is unsettled. Our aim was to assess the impact of recanalization on outcome in patients with baseline DWI lesion ≥70 mL (DWI≥70 mL) treated ≤4.5 hours from onset. We hypothesized that recanalization is beneficial in a sizeable fraction of these patients and that this is associated with a larger DWI lesion reversal. Methods-We analyzed 267 consecutive patients treated with intravenous recombinant tissue-type plasminogen activator for middle cerebral artery territory stroke in whom an occlusion was present on magnetic resonance angiography and 24-hour recanalization and 90-day clinical outcome could be assessed. After stratification relative to the 70-mL DWI lesion cut point, we calculated the odds ratio for recanalization of the primary arterial occlusive lesion (AOL score ≥2) to predict favorable outcome (modified Rankin scale score ≤2). DWI lesion reversal was compared between recanalizers with DWI≥70 mL with favorable and unfavorable outcomes. Results-Median (interquartile range) DWI lesion volume was 22 mL (10-60), and median onset time to imaging was 116 minutes (86-151). Twelve (22%) of the 54 patients with DWI≥70 mL experienced favorable outcome, of which 9 had recanalized. In patients with DWI≥70 mL, recanalization was significantly associated with favorable outcome after adjustment for age and National Institutes of Health Stroke Scale (odds ratio =4.

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Section: Discussionmentioning

confidence: 95%

Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization?

Tisserand

Turc

Charron

et al. 2016

Stroke

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“…Other studies used infarct core size on admission to describe the maximal core volume on admission compatible with long-term favorable outcome 22. These approaches may become unreliable if the observed core on admission is reversible.…”

Section: Discussionmentioning

confidence: 99%

Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept

Boned

Padroni²,

Rubiera

et al. 2016

J NeuroIntervent Surg

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148

147

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“…28 It has been reported that DWI lesion volume is a strong predictor of clinical outcome after endovascular treatment. 16,29 Recently, Ribo et al 29 suggested the concept of the maximal admission lesion volume compatible with favorable outcome, which was defined as the admission core volume above which the possibility of favorable outcome (mRS 0 -2) was Ͻ10% in patients with acute anterior circulation stroke. In their study, maximal admission lesion volume compatible with favorable outcome was found to DWI-ASPECTS is commonly used as surrogate for lesion volume to save time in an acute setting.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Are Not Different between Patients with Intermediate and High DWI-ASPECTS after Stent-Retriever Embolectomy for Acute Anterior Circulation Stroke

Kim¹,

Yoon²,

Park

et al. 2016

AJNR Am J Neuroradiol

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Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures

Abstract: Admission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures.

Cited by 34 publications

References 18 publications

Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization?

Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization?

Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept

Outcomes Are Not Different between Patients with Intermediate and High DWI-ASPECTS after Stent-Retriever Embolectomy for Acute Anterior Circulation Stroke

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