Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy

被引：5

作者：

Yedavalli, Vivek ^{[1
]}

Salim, Hamza Adel ^{[1
,2
,3
,4
]}

Musmar, Basel ^{[5
]}

Adeeb, Nimer ^{[5
]}

El Naamani, Kareem ^{[6
]}

Henninger, Nils ^{[7
]}

Sundararajan, Sri Hari ^{[8
]}

Kuhn, Anna Luisa ^{[9
]}

Khalife, Jane ^{[10
]}

Ghozy, Sherief ^{[11
,12
]}

Scarcia, Luca ^{[13
]}

Tan, Benjamin Y. Q. ^{[14
,15
]}

Regenhardt, Robert W. ^{[2
,3
]}

Heit, Jeremy J. ^{[16
]}

Cancelliere, Nicole M. ^{[17
,18
]}

Bernstock, Joshua D. ^{[19
]}

Rouchaud, Aymeric ^{[20
]}

Fiehler, Jens ^{[11
,12
,21
]}

Sheth, Sunil ^{[22
]}

Puri, Ajit S. ^{[9
]}

Dyzmann, Christian ^{[23
]}

Colasurdo, Marco ^{[21
]}

Barreau, Xavier ^{[22
]}

Renieri, Leonardo ^{[23
]}

Filipe, Joao Pedro ^{[24
]}

Harker, Pablo ^{[25
]}

Radu, Razvan Alexandru ^{[26
]}

Abdalkader, Mohamad ^{[27
,28
]}

Klein, Piers ^{[27
,28
]}

Marotta, Thomas R. ^{[17
,18
]}

Spears, Julian ^{[17
,18
]}

Ota, Takahiro ^{[29
]}

Mowla, Ashkan ^{[30
]}

Jabbour, Pascal ^{[6
]}

Biswas, Arundhati ^{[31
]}

Clarencon, Frederic ^{[32
,33
]}

Siegler, James E. ^{[10
]}

Nguyen, Thanh N. ^{[27
,28
]}

Varela, Ricardo ^{[34
]}

Baker, Amanda ^{[35
,36
]}

Essibayi, Muhammed Amir ^{[35
,36
]}

Altschul, David ^{[35
,36
]}

Gonzalez, Nestor R. ^{[37
]}

Moehlenbruch, Markus A. ^{[38
]}

Costalat, Vincent ^{[26
]}

Gory, Benjamin ^{[39
,40
]}

Stracke, Christian Paul ^{[41
]}

Aziz-Sultan, Mohammad Ali ^{[19
]}

Hecker, Constantin ^{[42
,43
]}

Shaikh, Hamza ^{[10
]}

机构：

[1] Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, 1800 Orleans St, Baltimore, MD 21218 USA

[2] Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA

[3] Harvard Med Sch, Brigham & Womens Hosp, Boston, MA USA

[4] Univ Texas MD Anderson Canc Ctr, Dept Neuroradiol, Houston, TX USA

[5] Louisiana State Univ, Dept Neurosurg & Intervent Neuroradiol, Baton Rouge, LA USA

[6] Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA USA

[7] Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA

[8] NJMS, Dept Endovasc Neurosurg & Neuroradiol, Newark, NJ USA

[9] Univ Massachusetts, Med Ctr, Dept Radiol, Div Neurointervent Radiol, Worcester, MA USA

[10] Rowen Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ USA

[11] Mayo Clin, Dept Neurol Surg, Rochester, MN USA

[12] Mayo Clin, Dept Radiol, Rochester, MN USA

[13] Henri Mondor Hosp, Dept Neuropathol, Creteil, France

[14] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore

[15] Natl Univ Singapore Hosp, Dept Med, Div Neurol, Singapore, Singapore

[16] Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA

[17] Univ Toronto, St Michael Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada

[18] Univ Toronto, St Michael Hosp, Neurovasc Ctr, Div Neurosurg, Toronto, ON, Canada

[19] Harvard Med Sch, Dept Neurosurg, Brigham & Womens Hosp, Boston, MA USA

[20] Univ Limoges, Neuroradiol Dept, Univ Hosp Limoges, Dupuytren,XLIM CNRS,UMR, Limoges, France

[21] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[22] UTHlth McGovern Med Sch, Dept Neurol, Houston, TX USA

[23] Sana Kliniken Lubeck GmbH, Neuroradiol Dept, Lubeck, Germany

[24] Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal

[25] Univ Cincinnati, Med Ctr, Dept Neurol, Cincinnati, OH USA

[26] Montpellier Univ Med Ctr, Gui Chauliac Hosp, Dept Neuroradiol, Montpellier, France

[27] Boston Med Ctr, Dept Neurol & Radiol, Boston, MA USA

[28] Boston Med Ctr, Dept Neurol, Boston, MA USA

[29] Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan

[30] Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovasc Neurosurg, Los Angeles, CA USA

[31] New York Med Coll, Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA

[32] Hop La Pitie Salpetriere, Dept Neuroradiol, Paris, France

[33] Sorbonne Univ, GRC BioFast, Paris, France

[34] Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal

[35] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Neurol Surg, Bronx, NY USA

[36] Montefiore Med Ctr, Albert Einstein Coll Med, Montefiore Einstein Cerebrovasc Res Lab, Bronx, NY USA

[37] Cedars Sinai Med Ctr, Dept Neurosurg, Los Angeles, CA USA

[38] Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany

[39] Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France

[40] Univ Lorraine, INSERM U1254, IADI, Vandoeuvre Les Nancy, France

[41] Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany

[42] Paracelsus Med Univ Salzburg, Dept Neurol, Christian Doppler Clin, Salzburg, Austria

[43] Paracelsus Med Univ Salzburg, Dept Neurosurg, Christian Doppler Clin, Salzburg, Austria

[44] UCLA, UCLA Stroke Ctr, Dept Neurol, Los Angeles, CA USA

[45] Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Rome, Italy

[46] Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium

[47] Univ Med Ctr Munster, Dept Radiol, Neuroendovasc Program, Munster, Germany

[48] Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium

来源：

EUROPEAN STROKE JOURNAL | 2024年

关键词：

Stroke; medium vessel occlusion; mechanical thrombectomy; follow-up infarct volume; ISCHEMIC LESION VOLUME; ATTENUATED INVERSION-RECOVERY; INDEPENDENT PREDICTOR; CLINICAL-RESPONSE; DIFFUSION; MRI;

D O I：

10.1177/23969873241275531

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT. Methods: This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT. Results: Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV <= 5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at <= 15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes. Conclusions: FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

引用

页数：11

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