Search

Background and ObjectivesThe effect of mechanical thrombectomy (MT) on functional outcome in patients with ischemic stroke with low ASPECTS is still uncertain. ASPECTS rating is based on the presence of ischemic hypoattenuation relative to normal; however, the degree of hypoattenuation, which directly reflects net uptake of water, is currently not considered an imaging biomarker in stroke triage. We hypothesized that the effect of thrombectomy on functional outcome in low ASPECTS patients depends on early lesion water uptake.MethodsFor this multicenter observational study, patients with anterior circulation stroke with ASPECTS ≤5 were consecutively analyzed. Net water uptake (NWU) was assessed as a quantitative imaging biomarker in admission CT. The primary end point was the rate of favorable functional outcome defined as modified Rankin Scale score 0–3 at day 90. The effect of recanalization on functional outcome was analyzed according to the degree of NWU within the early infarct lesion.ResultsA total of 254 patients were included, of which 148 (58%) underwent MT. The median ASPECTS was 4 (interquartile range [IQR] 3–5), and the median NWU was 11.4% (IQR 8.9%–15.1%). The rate of favorable outcome was 27.6% in patients with low NWU (p< 0.0001). In multivariable logistic regression analysis, NWU was an independent predictor of outcome, whereas vessel recanalization (modified thrombolysis in cerebral infarction ≥2b) was only significantly associated with better outcomes if NWU was lower than 12.6%. In inverse-probability weighting analysis, recanalization was associated with 20.7% (p= 0.01) increase in favorable outcome in patients with low NWU compared with 9.1% (p= 0.06) in patients with high NWU.DiscussionEarly NWU was independently associated with clinical outcome and might serve as an indicator of futile MT in low ASPECTS patients. NWU could be tested as a tool to select low ASPECTS patients for MT.Trial Registration InformationThe study is registered within theClinicalTrials.govProtocol Registration and Results System (NCT04862507).

IMPORTANCE Clinical evidence of the potential treatment benefit of intravenous thrombolysis preceding unsuccessful mechanical thrombectomy (MT) is scarce. OBJECTIVE To determine whether intravenous thrombolysis (IVT) prior to unsuccessful MT improves functional outcomes in patients with acute ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS Patients were enrolled in this retrospective cohort study from the prospective, observational, multicenter German Stroke Registry-Endovascular Treatment between May 1, 2015, and December 31, 2021. This study compared IVT plus MT vs MT alone in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion in whom mechanical reperfusion was unsuccessful. Unsuccessful mechanical reperfusion was defined as failed (final modified Thrombolysis in Cerebral Infarction grade of 0 or 1) or partial (grade 2a). Patients meeting the inclusion criteria were matched by treatment group using 1:1 propensity score matching. INTERVENTIONS Mechanical thrombectomy with or without IVT. MAIN OUTCOMES AND MEASURES Primary outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2. Safety outcomes were the occurrence of symptomatic intracranial hemorrhage and death. RESULTS After matching, 746 patients were compared by treatment arms (median age, 78 [IQR, 68-84] years; 438 women [58.7%]). The proportion of patients who were functionally independent at 90 days was 68 of 373 (18.2%) in the IVT plus MT and 42 of 373 (11.3%) in the MT alone group (adjusted odds ratio [AOR], 2.63 [95% CI, 1.41-5.11]; P = .003). There was a shift toward better functional outcomes on the modified Rankin Scale favoring IVT plus MT (adjusted common OR, 1.98 [95% CI, 1.35-2.92]; P

Supplemental material, sj-docx-1-ine-10.1177_15910199231170411 for Prediction of delayed cerebral ischemia after cerebral aneurysm rupture using explainable machine learning approach* by Reza M Taghavi, Guangming Zhu, Max Wintermark, Gabriella M Kuraitis, Eric S Sussman, Benjamin Pulli, Brook Biniam, Sophie Ostmeier and Gary K Steinberg, Jeremy J Heit in Interventional Neuroradiology

Supplemental material, sj-docx-1-ine-10.1177_15910199231185738 for Endovascular thrombectomy for ischemic stroke with large core volume: An updated, post-TESLA systematic review and meta-analysis of the randomized trials by Hassan Kobeissi, Gautam Adusumilli, Sherief Ghozy, Ramanathan Kadirvel, Waleed Brinjikji, Gregory W Albers, Jeremy J Heit and David F Kallmes in Interventional Neuroradiology

Supplemental material, sj-docx-1-ine-10.1177_15910199231152510 for Comparing Tigertriever 13 to other thrombectomy devices for distal medium vessel occlusion: A systematic review and meta-analysis by Gautam Adusumilli, Hassan Kobeissi, Sherief Ghozy and Kevin M. Kallmes, Waleed Brinjikji, David F. Kallmes, Jeremy J. Heit in Interventional Neuroradiology

Supplemental material, sj-docx-2-ine-10.1177_15910199231154331 for Mechanical thrombectomy alone versus with thrombolysis for ischemic stroke: A meta-analysis of randomized trials by Hassan Kobeissi, Gautam Adusumilli, Sherief Ghozy and Cem Bilgin, Ramanathan Kadirvel, Waleed Brinjikji, Jeremy J Heit, Alejandro A Rabinstein, David F Kallmes in Interventional Neuroradiology

Supplemental material, sj-pdf-1-jcb-10.1177_0271678X231179558 for The negative effect of aging on cerebral venous outflow in acute ischemic stroke by Christian Heitkamp, Laurens Winkelmeier, Jeremy J Heit, Fabian Flottmann, Christian Thaler, Helge Kniep, Gabriel Broocks, Lukas Meyer, Vincent Geest, Gregory W Albers, Maarten G Lansberg, Jens Fiehler and Tobias D Faizy in Journal of Cerebral Blood Flow & Metabolism

Supplemental material, sj-docx-2-ine-10.1177_15910199231154331 for Mechanical thrombectomy alone versus with thrombolysis for ischemic stroke: A meta-analysis of randomized trials by Hassan Kobeissi, Gautam Adusumilli, Sherief Ghozy and Cem Bilgin, Ramanathan Kadirvel, Waleed Brinjikji, Jeremy J Heit, Alejandro A Rabinstein, David F Kallmes in Interventional Neuroradiology

Supplemental material, sj-docx-1-ine-10.1177_15910199231152510 for Comparing Tigertriever 13 to other thrombectomy devices for distal medium vessel occlusion: A systematic review and meta-analysis by Gautam Adusumilli, Hassan Kobeissi, Sherief Ghozy and Kevin M. Kallmes, Waleed Brinjikji, David F. Kallmes, Jeremy J. Heit in Interventional Neuroradiology

Supplemental material, sj-docx-1-ine-10.1177_15910199231170411 for Prediction of delayed cerebral ischemia after cerebral aneurysm rupture using explainable machine learning approach* by Reza M Taghavi, Guangming Zhu, Max Wintermark, Gabriella M Kuraitis, Eric S Sussman, Benjamin Pulli, Brook Biniam, Sophie Ostmeier and Gary K Steinberg, Jeremy J Heit in Interventional Neuroradiology

Supplemental material, sj-pdf-1-jcb-10.1177_0271678X221127089 for Poor venous outflow profiles increase the risk of reperfusion hemorrhage after endovascular treatment by Laurens Winkelmeier, Jeremy J Heit, Gautam Adusumilli, Vincent Geest, Adrien Guenego, Gabriel Broocks, Julia Prüter, Nils-Ole Gloyer, Lukas Meyer, Helge Kniep, Maarten G Lansberg, Gregory W Albers, Max Wintermark, Jens Fiehler and Tobias D Faizy in Journal of Cerebral Blood Flow & Metabolism

Supplemental material, sj-docx-1-wso-10.1177_17474930211065635 for Venous outflow profiles are associated with early edema progression in ischemic stroke by Noel van Horn, Jeremy J Heit, Reza Kabiri, Gabriel Broocks, Soren Christensen, Michael Mlynash, Lukas Meyer, Michael H Schoenfeld, Maarten G Lansberg, Gregory W Albers, Jens Fiehler, Max Wintermark and Tobias D Faizy in International Journal of Stroke

Supplemental material, sj-docx-1-wso-10.1177_17474930211065635 for Venous outflow profiles are associated with early edema progression in ischemic stroke by Noel van Horn, Jeremy J Heit, Reza Kabiri, Gabriel Broocks, Soren Christensen, Michael Mlynash, Lukas Meyer, Michael H Schoenfeld, Maarten G Lansberg, Gregory W Albers, Jens Fiehler, Max Wintermark and Tobias D Faizy in International Journal of Stroke

Supplemental material, sj-docx-3-ine-10.1177_15910199221100796 for Mechanical thrombectomy in anterior vs. posterior circulation stroke: A systematic review and meta-analysis by Gautam Adusumilli, John M Pederson, Nicole Hardy and Kevin M Kallmes, Kristen Hutchison, Hassan Kobeissi, Daniel M Heiferman, Jeremy J Heit in Interventional Neuroradiology

Supplemental material, sj-pdf-1-ine-10.1177_15910199221100796 for Mechanical thrombectomy in anterior vs. posterior circulation stroke: A systematic review and meta-analysis by Gautam Adusumilli, John M Pederson, Nicole Hardy and Kevin M Kallmes, Kristen Hutchison, Hassan Kobeissi, Daniel M Heiferman, Jeremy J Heit in Interventional Neuroradiology

Supplemental material, sj-pdf-1-ine-10.1177_15910199221100796 for Mechanical thrombectomy in anterior vs. posterior circulation stroke: A systematic review and meta-analysis by Gautam Adusumilli, John M Pederson, Nicole Hardy and Kevin M Kallmes, Kristen Hutchison, Hassan Kobeissi, Daniel M Heiferman, Jeremy J Heit in Interventional Neuroradiology

Supplemental material, sj-pdf-1-jcb-10.1177_0271678X221127089 for Poor venous outflow profiles increase the risk of reperfusion hemorrhage after endovascular treatment by Laurens Winkelmeier, Jeremy J Heit, Gautam Adusumilli, Vincent Geest, Adrien Guenego, Gabriel Broocks, Julia Prüter, Nils-Ole Gloyer, Lukas Meyer, Helge Kniep, Maarten G Lansberg, Gregory W Albers, Max Wintermark, Jens Fiehler and Tobias D Faizy in Journal of Cerebral Blood Flow & Metabolism

Supplemental material, sj-pdf-1-jcb-10.1177_0271678X21992200 for Perfusion imaging-based tissue-level collaterals predict ischemic lesion net water uptake in patients with acute ischemic stroke and large vessel occlusion by Tobias D Faizy, Reza Kabiri, Soren Christensen, Michael Mlynash, Gabriella Kuraitis, Gabriel Broocks, Uta Hanning, Jawed Nawabi, Maarten G Lansberg, Michael P Marks, Gregory W Albers, Jens Fiehler, Max Wintermark and Jeremy J Heit in Journal of Cerebral Blood Flow & Metabolism

Supplemental material, JCB914537 Supplemental Material for Comparison of Tmax values between full- and half-dose gadolinium perfusion studies by Søren Christensen, Shalini Amukotuwa, Maarten G Lansberg, Stephanie Kemp, Jeremy J Heit, Michael Mlynash, Michael P Marks, Greg W Albers and Roland Bammer in Journal of Cerebral Blood Flow & Metabolism