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Abstract
Background and Objectives Endovascular thrombectomy (EVT) is effective for patients with large vessel occlusion (LVO) stroke with smaller volumes of CT perfusion (CTP)-defined ischemic core. However, the benefit of EVT is unclear in those with a core volume >70 mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core volume ≥70 mL, hypothesizing that there would be a benefit from EVT for fair outcome (3-month modified Rankin scale [mRS] 0–3) after stroke.
Methods A retrospective analysis of patients enrolled into a multicenter (Australia, China, and Canada) registry (2012–2020) who underwent CTP within 24 hours of stroke onset and had a baseline ischemic core volume ≥70 mL was performed. The primary outcome was the estimation of the association of EVT in patients with core volume ≥70 mL and within 70–100 and ≥100 mL subgroups with fair outcome.
Results Of the 3,283 patients in the registry, 299 had CTP core volume ≥70 mL and 269 complete data (135 had core volume between 70 and 100 mL and 134 had core volume ≥100 mL). EVT was performed in 121 (45%) patients. EVT-treated patients were younger (median 69 vs 75 years; p = 0.011), had lower prestroke mRS, and smaller median core volumes (92 [79–116.5] mL vs 105.5 [85.75–138] mL, p = 0.004). EVT-treated patients had higher odds of achieving fair outcome in adjusted analysis (30% vs 13.9% in the non-EVT group; adjusted odds ratio [aOR] 2.1, 95% CI 1–4.2, p = 0.038). The benefit was seen predominantly in those with 70–100 mL core volume (71/135 [52.6%] EVT-treated), with 54.3% in the EVT-treated vs 21% in the non-EVT group achieving a fair outcome (aOR 2.5, 95% CI 1–6.2, p = 0.005). Of those with a core volume ≥100 mL, 50 of the 134 (37.3%) underwent EVT. Proportions of fair outcome were very low in both groups (8.1% vs 8.7%; p = 0.908).
Discussion We found a positive association of EVT with the 3-month outcome after stroke in patients with a baseline CTP ischemic core volume 70–100 mL but not in those with core volume ≥100 mL. Randomized data to confirm these findings are required.
Classification of Evidence This study provides Class III evidence that EVT is associated with better motor outcomes 3 months after CTP-defined ischemic stroke with a core volume of 70–100 mL.
Glossary
- ASPECTS=
- Alberta stroke program early CT score;
- CTA=
- CT angiography;
- CTP=
- CT perfusion;
- DT=
- delay time;
- DWI=
- diffusion-weighted imaging;
- EVT=
- endovascular thrombectomy;
- ICA=
- internal carotid artery;
- INSPIRE=
- International Stroke Perfusion Imaging Registry;
- IQR=
- interquartile range;
- LVO=
- large vessel occlusion;
- mRS=
- modified Rankin scale;
- NCCT=
- noncontrast CT;
- NIHSS=
- NIH Stroke Scale;
- NNT=
- number needed to treat;
- OR=
- odds ratio;
- PH=
- parenchymal hematoma;
- RCT=
- randomized clinical trial;
- sICH=
- symptomatic hemorrhagic transformation;
- TICI=
- thrombolysis in cerebral infarction
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
INSPIRE Study Group coinvestigators are listed in the Appendix 2 at the end of the article.
Submitted and externally peer reviewed. The handling editors were José Merino, MD, MPhil, FAAN and Brad Worrall, MD, MSc, FAAN.
Class of Evidence: NPub.org/coe
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- Received November 22, 2021.
- Accepted in final form May 16, 2022.
- © 2022 American Academy of Neurology
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