Predictors of Early Neurological Improvement in Patients with Anterior Large Vessel Occlusion and Successful Reperfusion Following Endovascular Thrombectomy-Does CT Perfusion Imaging Matter?

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2022 Mar 4

PMID 35244728

Authors

Yan Li

Natalie van Landeghem

Aydin Demircioglu

Martin Kohrmann

Elias Kellner

Lennart Milles

Benjamin Stolte

Andreas Totzeck

Philipp Dammann

Karsten Wrede

Jens Matthias Theysohn

Hanna Styczen

Michael Forsting

Isabel Wanke

Benedikt Frank

Cornelius Deuschl

Affiliations

Soon will be listed here.

Abstract

Purpose: We aimed to investigate treatment effect of endovascular thrombectomy (EVT) on the change of National Institutes of Health Stroke Scale (NIHSS) scores in acute ischemic stroke (AIS) patients with anterior large vessel occlusion (LVO). Predictors of early neurological improvement (ENI) were assessed in those with successful reperfusion.

Methods: Data on stroke patients from January 2018 to December 2020 were retrospectively analyzed. Anterior LVO was defined as occlusion of internal carotid artery and/or M1/M2 branch of middle cerebral artery. A reduction of at least 8 NIHSS points at 24 h after EVT or NIHSS score ≤ 1 at discharge was defined as ENI. In patients with successful reperfusion (TICI score of 2b/3) and available CT perfusion (CTP) imaging, 20 variables were tested in a smoothed ridge regression for their association with ENI.

Results: One hundred seventy two out of 211 patients had successful perfusion with 54 patients achieving ENI. Impact of successful EVT on reducing NIHSS score grew continuously on a daily basis up to the date of discharge. 105 out of 172 patients were included in final regression model. Short time from onset to admission and from groin-puncture to reperfusion, young age, low prestroke disability, high baseline CTP ASPECTS and high follow-up non-contrast CT (NCCT) ASPECTS were significantly associated with ENI. Neither baseline NCCT ASPECTS nor the volume of penumbra or ischemic core measured on CTP were associated with ENI.

Conclusion: CTP ASPECTS might better predict ENI than non-contrast CT at baseline in patients with successful reperfusion following EVT.

Citing Articles

Impact of post-thrombectomy isolated subarachnoid hemorrhage on neurological outcomes in patients with anterior ischemic stroke - a retrospective single-center observational study.

van Landeghem N, Ziegenfuss C, Demircioglu A, Dammann P, Jabbarli R, Haubold J Neuroradiology. 2024; 66(10):1737-1745.

PMID: 38980345 PMC: 11424715. DOI: 10.1007/s00234-024-03424-w.

Investigating Neurologic Improvement After IV Thrombolysis: The Effect of Time From Stroke Onset vs Imaging-Based Tissue Clock.

Broocks G, Meyer L, Bechstein M, Hanning U, Kniep H, Schlemm E Neurology. 2023; 101(17):e1678-e1686.

PMID: 37657940 PMC: 10624495. DOI: 10.1212/WNL.0000000000207714.

Deep Learning-based Assessment of Internal Carotid Artery Anatomy to Predict Difficult Intracranial Access in Endovascular Recanalization of Acute Ischemic Stroke.

Nageler G, Gergel I, Fangerau M, Breckwoldt M, Seker F, Bendszus M Clin Neuroradiol. 2023; 33(3):783-792.

PMID: 36928398 PMC: 10449951. DOI: 10.1007/s00062-023-01276-0.

Elevated NT-proBNP levels are associated with CTP ischemic volume and 90-day functional outcomes in acute ischemic stroke: a retrospective cohort study.

Shen X, Liao J, Jiang Y, Xu Y, Liu M, Zhang X BMC Cardiovasc Disord. 2022; 22(1):431.

PMID: 36180827 PMC: 9524121. DOI: 10.1186/s12872-022-02861-w.

References

Wirtz M, Hendrix P, Goren O, Beckett L, Dicristina H, Schirmer C . Predictor of 90-day functional outcome after mechanical thrombectomy for large vessel occlusion stroke: NIHSS score of 10 or less at 24 hours. J Neurosurg. 2019; 134(1):115-121. DOI: 10.3171/2019.10.JNS191991. View

Mazighi M, Meseguer E, Labreuche J, Serfaty J, Laissy J, Lavallee P . Dramatic recovery in acute ischemic stroke is associated with arterial recanalization grade and speed. Stroke. 2012; 43(11):2998-3002. DOI: 10.1161/STROKEAHA.112.658849. View

Saver J, Goyal M, van der Lugt A, Menon B, Majoie C, Dippel D . Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016; 316(12):1279-88. DOI: 10.1001/jama.2016.13647. View

Cilluffo G, Sottile G, La Grutta S, Muggeo V . The Induced Smoothed lasso: A practical framework for hypothesis testing in high dimensional regression. Stat Methods Med Res. 2019; 29(3):765-777. DOI: 10.1177/0962280219842890. View

Zelenak K, Krajina A, Meyer L, Fiehler J, Esmint Artificial Intelligence And Robotics Ad Hoc Committee , Behme D . How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods. Life (Basel). 2021; 11(6). PMC: 8229281. DOI: 10.3390/life11060488. View

Bivard A, Kleinig T, Miteff F, Butcher K, Lin L, Levi C . Ischemic core thresholds change with time to reperfusion: A case control study. Ann Neurol. 2017; 82(6):995-1003. PMC: 6712948. DOI: 10.1002/ana.25109. View

Chalos V, van der Ende N, Lingsma H, Mulder M, Venema E, Dijkland S . National Institutes of Health Stroke Scale: An Alternative Primary Outcome Measure for Trials of Acute Treatment for Ischemic Stroke. Stroke. 2019; 51(1):282-290. PMC: 6924951. DOI: 10.1161/STROKEAHA.119.026791. View

Nogueira R, Jadhav A, Haussen D, Bonafe A, Budzik R, Bhuva P . Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2017; 378(1):11-21. DOI: 10.1056/NEJMoa1706442. View

Gao J, Parsons M, Kawano H, Levi C, Evans T, Lin L . Visibility of CT Early Ischemic Change Is Significantly Associated with Time from Stroke Onset to Baseline Scan beyond the First 3 Hours of Stroke Onset. J Stroke. 2017; 19(3):340-346. PMC: 5647641. DOI: 10.5853/jos.2016.01424. View

10.

Bourcier R, Goyal M, Liebeskind D, Muir K, Desal H, Siddiqui A . Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials. JAMA Neurol. 2019; 76(4):405-411. PMC: 6459219. DOI: 10.1001/jamaneurol.2018.4510. View

11.

Goyal M, Menon B, van Zwam W, Dippel D, Mitchell P, Demchuk A . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387(10029):1723-31. DOI: 10.1016/S0140-6736(16)00163-X. View

12.

van Horn N, Kniep H, Leischner H, McDonough R, Deb-Chatterji M, Broocks G . Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients. J Neurointerv Surg. 2020; 13(1):14-18. DOI: 10.1136/neurintsurg-2020-015889. View

13.

Jayaraman M, Grossberg J, Meisel K, Shaikhouni A, Silver B . The clinical and radiographic importance of distinguishing partial from near-complete reperfusion following intra-arterial stroke therapy. AJNR Am J Neuroradiol. 2012; 34(1):135-9. PMC: 7966350. DOI: 10.3174/ajnr.A3278. View

14.

Psychogios M, Sporns P, Ospel J, Katsanos A, Kabiri R, Flottmann F . Automated Perfusion Calculations vs. Visual Scoring of Collaterals and CBV-ASPECTS : Has the Machine Surpassed the Eye?. Clin Neuroradiol. 2020; 31(2):499-506. PMC: 8211603. DOI: 10.1007/s00062-020-00974-3. View

15.

Borst J, Berkhemer O, Roos Y, van Bavel E, van Zwam W, van Oostenbrugge R . Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment. Stroke. 2015; 46(12):3375-82. DOI: 10.1161/STROKEAHA.115.010564. View

16.

Garcia-Tornel A, Campos D, Rubiera M, Boned S, Olive-Gadea M, Requena M . Ischemic Core Overestimation on Computed Tomography Perfusion. Stroke. 2021; 52(5):1751-1760. DOI: 10.1161/STROKEAHA.120.031800. View

17.

Tsang A, Lenck S, Hilditch C, Nicholson P, Brinjikji W, Krings T . Automated CT Perfusion Imaging Versus Non-contrast CT for Ischemic Core Assessment in Large Vessel Occlusion. Clin Neuroradiol. 2018; 30(1):109-114. DOI: 10.1007/s00062-018-0745-6. View

18.

Wang T, Chen L, Jin X, Yuan Y, Zhang Q, Shao C . CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion. BMC Med Imaging. 2021; 21(1):67. PMC: 8040219. DOI: 10.1186/s12880-021-00593-5. View

19.

Heit J, Mlynash M, Kemp S, Lansberg M, Christensen S, Marks M . Rapid Neurologic Improvement Predicts Favorable Outcome 90 Days After Thrombectomy in the DEFUSE 3 Study. Stroke. 2019; 50(5):1172-1177. PMC: 6476661. DOI: 10.1161/STROKEAHA.119.024928. View

20.

Albers G, Marks M, Kemp S, Christensen S, Tsai J, Ortega-Gutierrez S . Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018; 378(8):708-718. PMC: 6590673. DOI: 10.1056/NEJMoa1713973. View