Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core

Eyad Almallouhi, Sara Zandpazandi, Mohammad Anadani, Conor Cunningham, Mohammad Mahdi Sowlat, Hidetoshi Matsukawa, Atakan Orscelik, Sameh Samir Elawady, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Edgar A. Samaniego, Adam S. Arthur, Shinichi Yoshimura, Hugo CuellarJonathan A. Grossberg, Ali Alawieh, Daniele G. Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam J. Polifka, Joshua W. Osbun, Roberto Javier Crosa, Charles Matouk, Min S. Park, Michael R. Levitt, Waleed Brinjikji, Mark Moss, Travis M. Dumont, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel A. Chowdhry, Mohamad Ezzeldin, Alejandro M. Spiotta

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2). Methods Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. Results We identified 58 patients who presented with ASPECTS 0-2 and underwent MT. Median age was 74.0 (66.3-80.0) years, 30 (51.7%) were females, and 16 (27.6%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 34 (64.2%) patients and stent retriever was used in 8 (15.1%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 41.4%, 31% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. Conclusions This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.

Original languageEnglish (US)
Pages (from-to)1268-1274
Number of pages7
JournalJournal of neurointerventional surgery
Volume16
Issue number12
DOIs
StatePublished - Nov 22 2024

Keywords

  • Intervention
  • Intracranial Thrombosis
  • Stenosis
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core'. Together they form a unique fingerprint.

Cite this