Eloquence-based reperfusion scoring and its ability to predict post-thrombectomy disability and functional status

Abstract

Background Angiographic reperfusion after endovascular thrombectomy in acute ischemic stroke is commonly graded using volume-based reperfusion scores such as the modified thrombolysis in cerebral infarct score. The location of non-reperfused regions is not included in modified thrombolysis in cerebral infarct score. We studied the predictive ability of an eloquence-based reperfusion score. Methods Consecutive cases of endovascular thrombectomy for anterior circulation strokes performed between January 2018 and April 2020 were included. Digital subtraction angiograms were reviewed by two blinded neurointerventionalist operators. Incomplete reperfusion was further classified by lobar regions lacking reperfusion to create various cohorts. Outcomes were graded four to seven days post-procedure with the National Institute of Health Stroke Scale (NIHSS) and 90 days post-procedure with the modified Rankin Scale. Results One hundred patients were identified. Via multivariate analysis, we found that frontal lobe non-reperfusion (mean difference (MD) = −1.60, p = 0.002) and occipital lobe non-reperfusion (MD = −1.68, p = 0.001) were associated with worse mental status improvement while left-sided stroke (MD = 2.02, p < 0.001) featured better improvement post-thrombectomy. Occipital lobe non-reperfusion (MD = −0.734, p = 0.009) was associated with the worse improvement of visual fields. The non-reperfusion of the frontal lobe was associated with a 1.732-worse NIHSS hemibody strength score (95% confidence interval (95%CI) = −3.39 to −0.072, p = 0.041). Worse improvement in NIHSS scores was found to be associated with frontal lobe non-reperfusion (MD = −5.34, 95%CI = −9.52 to −1.18, p = 0.013) and occipital lobe non-reperfusion (MD = −6.35, 95%CI = −10.4 to −2.31, p = 0.002). Odds of achieving modified Rankin Scale of 0–2 at 90 days were decreased with frontal lobe non-reperfusion (odds ratio (OR) = 0.279, 95%CI = 0.090–0.869, p = 0.028) and left laterality (OR = 0.376, 95%CI = 0.153–0.922, p = 0.033). Conclusions Eloquence-based reperfusion assessment is an important predictor for functional outcomes after thrombectomy.

Value of Immediate Flat Panel Perfusion Imaging after Endovascular Therapy (AFTERMATH): A Proof of Concept Study

“…The remaining 26 patients were included in the agreement analysis (Fig 3). In the final study cohort, 69% of the patients were male; mean age was 77 years (IQR, 61-83); and median NIHSS score at admission was 15 (IQR,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Medium DSA-to-FPCT-PI time was 4 minutes 18 seconds (IQR 3 minutes 12 seconds-7 minutes 30 seconds).…”

“…1 Locations of the residual occlusions after MT were classified into frontal, parietal, temporal, and occipital regions (Online Supplemental Data). 20 For comparative purposes, we also reported TICI reperfusion as graded by the operating interventionalist at the end of the procedure, by extracting the scores from the acute interventional report that was filled out immediately after the procedure. Whenever the eTICI is reported, it refers to the core lab adjudicated grading, whereas TICI refers to the operators' assessment, as no eTICI was available from the operators' reports.…”