Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core

García-Esperón, Carlos; Bivard, Andrew; Johns, Hannah; Chen, Chushuang; Чурилов, Леонид; Lin, Longting; Butcher, Kenneth; Kleinig, Timothy; Choi, Philip; Cheng, Xin; Dong, Qiang; Aviv, Richard I.; Miteff, Ferdinand; Spratt, Neil; Levi, Christopher

doi:10.1212/wnl.0000000000200908

Cited by 14 publications

(14 citation statements)

References 29 publications

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“…As 2 of the cohort studies did not include mortality data, they were not included in the mortality analysis. 24,25 The GRADE quality of the RCT evidence was moderate and that of the cohort studies was very low (eFigure 2, links.lww.com/WNL/C859).…”

Section: Resultsmentioning

confidence: 99%

Mechanical Thrombectomy for Large Ischemic Stroke

Abdalkader

Siegler

et al. 2023

Neurology

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Background and ObjectivesThere is growing evidence for endovascular thrombectomy (EVT) in patients with large ischemic core infarct and large vessel occlusion. The objective of this study was to compare the efficacy and safety of EVT versus medical management (MM) via a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs).MethodsWe searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to mechanical thrombectomy for large ischemic core from inception until February 10, 2023. The primary outcome was independent ambulation (modified Rankin Scale [mRS] 0-3). Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. The quality of articles was evaluated through the Cochrane risk assessment tool and Newcastle-Ottawa scale. This study was registered in PROSPERO (CRD42023396232).ResultsA total of 5395 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded by review of the title, abstract, and full text. Finally, 3 RCTs and 10 cohort studies met the inclusion criteria. The RCT analysis showed that EVT improved the 90-day functional outcomes of patients with large ischemic core with high-quality evidence, including independent ambulation (mRS 0-3: RR 1.78, 95% CI 1.28-2.48, P < 0.001) and functional independence (mRS 0-2: RR 2.59, 95% CI 1.89-3.57, P < 0.001), but without significantly increasing the risk of symptomatic intracranial hemorrhage (sICH: RR 1.83, 95% CI: 0.95-3.55, P = 0.07) or early mortality (RR 0.95, 95% CI 0.78-1.16, P = 0.61). Analysis of the cohort studies showed that EVT improved functional outcomes of patients without an increase in the incidence in sICH.ConclusionThis systematic review and meta-analysis indicates that in patients with large vessel occlusion stroke with a large ischemic core, EVT was associated with improved functional outcomes over medical management without increasing sICH risk. Results of ongoing RCTs may provide further insight in this patient population.

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Section: Resultsmentioning

confidence: 99%

Mechanical Thrombectomy for Large Ischemic Stroke

Abdalkader

Siegler

et al. 2023

Neurology

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“…A study recently published by the INSPIRE study group included 269 patients with core volume at least 70 ml. In this trial, EVT was associated with better outcome among patients with core volume 70–100 ml, but not in those with core volume above 100 ml [38 ▪ ]. EVT was also reported to be cost-effective compared with medical therapy over the lifetime of patients with LIC [39].…”

Section: Large Corementioning

confidence: 77%

“…The potential beneficial effect of EVT for patients with large infarcts is also supported by the results of several registries and secondary analyses studies [33–35,37,38 ▪ ]. A study recently published by the INSPIRE study group included 269 patients with core volume at least 70 ml.…”

Section: Large Corementioning

confidence: 89%

Current advances in endovascular treatment

Molad

Honig

2023

Current Opinion in Neurology

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Purpose of reviewEndovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients selection and periprocedural management. Recent findingsRecent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.

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“…In previous studies, the proportion of good outcomes in patients with large infarct cores who underwent endovascular thrombectomy ranged from 8% to 52% 9–13,24 . The reasons for this phenomenon are numerous: (1).…”

Section: Discussionmentioning

confidence: 99%

Nomogram to predict unfavorable outcome of endovascular thrombectomy for large ischemic core

Han,

Zhang,

Zhang

et al. 2023

Ann Clin Transl Neurol

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ObjectiveThe prognosis for patients presenting with a large ischemic core (LIC) following endovascular thrombectomy is relatively poor. This study aimed to construct and validate a nomogram for predicting 3‐month unfavorable outcome in patients with anterior circulation occlusion‐related LIC who underwent endovascular thrombectomy.MethodsA retrospective training cohort and a prospective validation cohort of patients with a large ischemic core were studied. The diffusion weighted imaging related radiomic features and pre‐thrombectomy clinical features were collected. After the selection of relevant features, a nomogram predicting modified Rankin Scale score of 3–6 as an unfavorable outcome was established. The discriminatory value of the nomogram was evaluated with a receiver operating characteristic curve.ResultsA total of 140 patients (mean age 66.3 ± 13.4 years, 35% female) were included in this study, consisting of a training cohort (n = 95) and a validation cohort (n = 45). The percentage of patients with an mRS scores of 0–2 was 30%, 0–3 was 40.7%, and 32.9% were dead. Age, National Institute of Health Stroke Scale (NIHSS) score, and two radiomic features, Maximum2DDiameterColumn and Maximum2DDiameterSlice, were identified as factors associated with unfavorable outcome in the nomogram. The nomogram demonstrated an area under the curve of 0.892 (95% confidence interval [CI], 0.812–0.947) in the training dataset and 0.872 (95% CI, 0.739–0.953) in the validation dataset.InterpretationThis nomogram, which includes age, NIHSS score, Maximum2DDiameterColumn, and Maximum2DDiameterSlice, may predict the risk of unfavorable outcome in patients with LIC caused by anterior circulation occlusion.

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Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core

Cited by 14 publications

References 29 publications

Mechanical Thrombectomy for Large Ischemic Stroke

Mechanical Thrombectomy for Large Ischemic Stroke

Current advances in endovascular treatment

Nomogram to predict unfavorable outcome of endovascular thrombectomy for large ischemic core

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