Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy

Davoli, Alessandro; Motta, Caterina; Koch, Giacomo; Diomedi, Marina; Napolitano, Simone; Giordano, Angela; Panella, Marta; Morosetti, Daniele; Fabiano, Sebastiano; Floris, Roberto; Gandini, Roberto; Sallustio, Fabrizio

doi:10.1136/neurintsurg-2017-013224

Cited by 34 publications

(26 citation statements)

References 22 publications

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“…23 Furthermore, our study made adjustments for post-treatment powerful predictors of MMI, infarct size and PH2, which were not included in the previous analyses. 22,23 In particular, our results are in agreement with the recent secondary analyses from data of randomized controlled trials, which suggested that baseline collateral status on CTA is a robust determinant of clinical outcomes in patients undergoing ET. 18,24 Thus, the treatment benefit may be absent in patients with poor collateral circulation.…”

Section: Journal Of Neurosonology and Neuroimagingsupporting

confidence: 91%

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Pretreatment Collateral Status Predicts Malignant Stroke Evolution in Patients Undergoing Endovascular Thrombectomy

Kim

Lee

2019

J Neurosonol Neuroimag

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Background: Early detection and management of malignant middle cerebral artery infarct (MMI) is clinically crucial, and many studies have investigated the predictors of MMI evolution. However, to date, little is known about MMI predictors in patients undergoing endovascular thrombectomy (ET). Therefore, this study attempts to investigate MMI predictors in these patients using a single center retrospective data. Methods: Ninety-three patients treated with ET for anterior circulation stroke were analyzed. From pretreatment computed tomographic angiography (CTA), the collateral score was rated from 0 to 3 (0, 0% filling of the occluded territory; 1, >0% and ≤50% filling; 2, >50% and <100% filling; 3, 100% filling). The parenchymal hemorrhage and the size of the infarct were determined by gradient echo and diffusion-weighted magnetic resonance imaging performed 24 hours after the ET. Patients with and without MMI were compared with regard to demographic, clinical and radiological data. Using a multivariate logistic regression model, the independent predictors of MMI were confirmed. Results: Nineteen patients (20.4%) developed MMI. There were no signif icant differences between patients with and without MMI with regard to the rate of vascular risk factors and recanalization failure. Taken together, poor collateral circulation (collateral score 0 or 1), an infarct size >2/3 middle cerebral artery territory, and type 2 parenchymal hemorrhage formed the significant independent predictor of MMI. Conclusion: The collateral status based on pretreatment CTA independently predicts MMI evolution, and can, therefore, help early detection and management of MMI in patients undergoing ET.

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Section: Journal Of Neurosonology and Neuroimagingsupporting

confidence: 91%

“…22,23 A study showed that CTA-SI ASPECTS was an independent predictor of MMI in a model that did not include collateral status. 22 In fact, CTA-SI ASPECTS may reflect abnormalities of cerebral blood volume at tissue level. Thus it may correspond to final infarct volume and clinical outcomes.…”

Section: Journal Of Neurosonology and Neuroimagingmentioning

confidence: 99%

Pretreatment Collateral Status Predicts Malignant Stroke Evolution in Patients Undergoing Endovascular Thrombectomy

Kim

Lee

2019

J Neurosonol Neuroimag

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“…The multivariate model used in our study was as follows : 1) selection of independent variables. We included those CTA variables determined to have been associated with sICH or MMCAI from previous studies 3,5,15) . We analyzed the area under the receiver operating characteristic curve (AUC-ROC) to determine the best cut-off point of the CTA parameters to identify patients with sICH and/or MMCAI after EVT in the derivation cohort.…”

Section: Statistics Analysismentioning

confidence: 99%

Can Computed Tomographic Angiography Be Used to Predict Who Will Not Benefit from Endovascular Treatment in Patients with Acute Ischemic Stroke? The CTA-ABC Score

Kwak

Park

2020

J Korean Neurosurg Soc

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Objective :The objective of this study was to develop a score to predict patients with acute ischemic stroke (AIS) who will not benefit from endovascular treatment (EVT) using computed tomographic angiography (CTA) parameters. Methods : The CTA-ABC score was developed from 3 scales previously described in the literature: the Alberta Stroke Program Early CT Score (0-5 points, 3; 6-10 points, 0), the clot burden score (0-3 points, 1; 4-10 points, 0), and the leptomeningeal Collateral score (0-1 points, 2; 2-3 points, 0). We evaluated the predictive value of CTA parameters associated with symptomatic intracranial hemorrhage (sICH) or malignant middle cerebral artery infarction (MMCAI) after EVT and developed the score using logistic regression coefficients. The score was then validated. Performance of the score was tested with an area under the receiver operating characteristic curve (AUC-ROC). Results : The derivation cohort consisted of 115 and the validation cohort consisted of 40 AIS patients. The AUC-ROC was 0.97 (95% confidence interval [CI], 0.94-0.99; p<0.001) in the derivation cohort. The proportions of patients with sICH and/or MMCAI in the derivation cohort were 96%, 73%, 6%, and 0% for scores of 6, 5, 1, and 0 points, respectively. In the validation group, the proportions were similar (90%, 100%, 0%, and 0%, respectively) with an AUC-ROC of 0.96 (95% CI, 0.90-1.00; p<0.001). Conclusion : Our CTA-ABC score reliably assessed risk for sICH and/or MMCAI in patients with AIS who underwent EVT. It can support clinical decision-making, especially when the need for EVT is uncertain. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.CTA-ABC Score | Kwak HS, et al.

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“…110 Clinical factors that were predictive of impending malignant infarction post-EVT were a high NIHSS (≥ 20 or ≥15 for left and right hemispheres respectively), a high admission BP, and hyperglycemia (with failure of control within 48 hours). 111,112 Radiologically, the strongest predictor was a CT ASPECTS (Alberta Stroke Program Early CT Score) ≤ 5 or a diffusion-weighted imaging (DWI) core volume of > 80 mL with a low sensitivity but high specificity. 111,113 Other measures: Patients may be extubated based on the neurologist/anesthetist's assessment.…”

Section: Posttreatment Managementmentioning

confidence: 99%

“…111,112 Radiologically, the strongest predictor was a CT ASPECTS (Alberta Stroke Program Early CT Score) ≤ 5 or a diffusion-weighted imaging (DWI) core volume of > 80 mL with a low sensitivity but high specificity. 111,113 Other measures: Patients may be extubated based on the neurologist/anesthetist's assessment. Airway support and ventilator assistance may be continued if there is evidence of continued depressed sensorium or lack of airway protection secondary to bulbar dysfunction.…”

Section: Posttreatment Managementmentioning

confidence: 99%

Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part II: Patient Selection, Endovascular Thrombectomy, and Postprocedure Management

Nagesh

2018

J Clin Interv Radiol ISVIR

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Appropriate patient selection and expedient recanalization are the mainstay of modern management of acute ischemic stroke (AIS). Only a minority of patients (7–15%) of patients are eligible for endovascular therapy. Patient selection may be time based or perfusion based. Central to both paradigms is the selection of a patient with a small core, a significant penumbra that can be differentiated from areas of oligemia. A brief review of patient selection methods is presented. Endovascular thrombectomy techniques using stentrievers or aspiration catheters have now become the treatment of choice for AIS with large vessel occlusion. A range of devices, each with its own advantages and disadvantages, are available in the market for the neurointerventionist to choose. Techniques vary between devices and between operators, but standardization and protocolization are important within each center. Complications must be anticipated to be avoided. Once reperfusion is achieved, outcomes must be safeguarded with competent postprocedure management to prevent secondary brain injury. These aspects are reviewed in this article.

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Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy

Abstract: in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.

Cited by 34 publications

References 22 publications

Pretreatment Collateral Status Predicts Malignant Stroke Evolution in Patients Undergoing Endovascular Thrombectomy

Pretreatment Collateral Status Predicts Malignant Stroke Evolution in Patients Undergoing Endovascular Thrombectomy

Can Computed Tomographic Angiography Be Used to Predict Who Will Not Benefit from Endovascular Treatment in Patients with Acute Ischemic Stroke? The CTA-ABC Score

Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part II: Patient Selection, Endovascular Thrombectomy, and Postprocedure Management

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