Marc Ribo1, Alejandro Tomasello2, Miguel Lemus2, Marta Rubiera2, Carla Vert2, Alan Flores2, Pilar Coscojuela2, Jorge Pagola2, David Rodriguez-Luna2, Sandra Bonet2, Marian Muchada2, Alex Rovira2, Carlos A Molina2. 1. From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. marcriboj@hotmail.com. 2. From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND AND PURPOSE: Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM). METHODS: We studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume-computed tomography perfusion or diffusion weighted imaging-magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is <10%. RESULTS: Fifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume was 28±22 mL, and recanalization thrombolysis in cerebral ischemia 2b-3 was 77%. At 24 hours, mean infarct volume was 64±97 mL, and at 3 months modified Rankin Scale 0 to 2 was 45%. Median lesion growth was smaller in recanalizers (16.7% versus 198.3%; P<0.01). MALCOM was 39 mL. When recanalization was achieved, 64% of patients within MALCOM (<39 mL) achieved favorable outcome, whereas despite recanalization only 12% of patients beyond MALCOM (>39 mL) achieved modified Rankin Scale 0 to 2 (P=0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having admission core lesion below MALCOM (OR: 9.3, 95% CI: 1.9-46.4; P<0.01). Analysis according to imaging modality showed that computed tomography-cerebral blood volume allowed larger MALCOM (42 mL) than magnetic resonance-diffusion weighted imaging (29 mL). In octogenarians, MALCOM (15 mL) was lower in younger patients (40 mL). CONCLUSIONS: Admission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures.
BACKGROUND AND PURPOSE: Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM). METHODS: We studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume-computed tomography perfusion or diffusion weighted imaging-magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is <10%. RESULTS: Fifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume was 28±22 mL, and recanalization thrombolysis in cerebral ischemia 2b-3 was 77%. At 24 hours, mean infarct volume was 64±97 mL, and at 3 months modified Rankin Scale 0 to 2 was 45%. Median lesion growth was smaller in recanalizers (16.7% versus 198.3%; P<0.01). MALCOM was 39 mL. When recanalization was achieved, 64% of patients within MALCOM (<39 mL) achieved favorable outcome, whereas despite recanalization only 12% of patients beyond MALCOM (>39 mL) achieved modified Rankin Scale 0 to 2 (P=0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having admission core lesion below MALCOM (OR: 9.3, 95% CI: 1.9-46.4; P<0.01). Analysis according to imaging modality showed that computed tomography-cerebral blood volume allowed larger MALCOM (42 mL) than magnetic resonance-diffusion weighted imaging (29 mL). In octogenarians, MALCOM (15 mL) was lower in younger patients (40 mL). CONCLUSIONS: Admission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures.
Authors: K Nael; E Tadayon; D Wheelwright; A Metry; J T Fifi; S Tuhrim; R A De Leacy; A H Doshi; H L Chang; J Mocco Journal: AJNR Am J Neuroradiol Date: 2019-08-14 Impact factor: 3.825
Authors: Nuno Martins; Ana Aires; Beatriz Mendez; Sandra Boned; Marta Rubiera; Alejandro Tomasello; Pilar Coscojuela; David Hernandez; Marián Muchada; David Rodríguez-Luna; Noelia Rodríguez; Jesús M Juega; Jorge Pagola; Carlos A Molina; Marc Ribó Journal: Interv Neurol Date: 2018-08-31
Authors: Claus Z Simonsen; Irene K Mikkelsen; Sanja Karabegovic; Pia Kjaer Kristensen; Albert J Yoo; Grethe Andersen Journal: Front Neurol Date: 2017-10-30 Impact factor: 4.003