Predicting severe disability or death in endovascular thrombectomy with large computed tomography perfusion core infarction and limited penumbra

Abstract

Background Patients presenting with large core infarctions benefit from treatment with endovascular thrombectomy (EVT), with a notable 50% reduction in rates of severe disability (modified Rankin Scale [mRS] 5) at 90 days. We studied the ability of previously reported prognostic scales to predict devastating outcomes in patients with a large ischemic core and limited salvageable brain tissue. Methods Retrospective analysis from a health system's code stroke registry, including consecutive thrombectomy patients from November 2017 to December 2022 with an anterior circulation large vessel occlusion, computed tomography perfusion core infarct ≥ 50 ml, and mismatch volume < 15 ml or mismatch ratio < 1.8. Previously reported scales were compared using logistic regression and area under the curve (AUC) analyses to predict 90-day mRS 5-6. Results Sixty patients (mean age 62.38 ± 14.25 years, median core volume 103 ml [74.75–153]) met inclusion criteria, of whom 27 (45%) had 90-day mRS 5-6. The Charlotte Large artery occlusion endovascular therapy Outcome Score (CLEOS) (odds ratio [OR] 1.35, 95% CI [1.14–1.60], p = 0.0005), Houston Intra-Arterial Therapy-2 (OR 1.35, 95% CI [1.00–1.83], p = 0.0470), and Totaled Health Risks in Vascular Events (OR 1.53, 95% CI [1.07–2.18], p = 0.0199) predicted the primary outcome in the logistic regression analysis. CLEOS performed best in the AUC analysis (AUC 0.83, 95% CI [0.72–0.94]). Conclusion CLEOS predicts devastating outcomes after EVT in patients with large core infarctions and small volumes of ischemic penumbra.