Pietro Panni1, Bertrand Lapergue2, Benjamin Maïer3, Stephanos Finitsis4, Frédéric Clarençon5, Sébastien Richard6,7, Gaultier Marnat8, Romain Bourcier3, Igor Sibon9, Cyril Dargazanli10, Raphaël Blanc11, Arturo Consoli12, François Eugène13, Stéphane Vannier14, Laurent Spelle15, Christian Denier16, Marion Boulanger17, Maxime Gauberti18, Suzana Saleme19, Francisco Macian20, Charlotte Rosso21, Olivier Naggara22, Guillaume Turc23, Ozlem Ozkul-Wermester24, Chrisanthi Papagiannaki25, Jean-François Albucher26, Jean Darcourt27, Anthony Le Bras28, Sarah Evain29, Valérie Wolff30, Raoul Pop31, Serge Timsit32, Jean-Christophe Gentric33, Frédéric Bourdain34, Louis Veunac35, Caroline Arquizan36, Benjamin Gory37,38. 1. Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy. panni.pietro@hsr.it. 2. Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. 3. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France. 4. AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 5. Department of Neuroradiology, CHU Pitié-Salpétrière, Paris, France. 6. CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine, 54000, Nancy, France. 7. CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France. 8. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France. 9. Neurology, University Hospital of Bordeaux, Bordeaux, France. 10. Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France. 11. Department of Neuroradiology, University Hospital of Nantes, Nantes, France. 12. Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. 13. Department of Neuroradiology, University Hospital of Rennes, Rennes, France. 14. Neurology, University Hospital of Rennes, Rennes, France. 15. Neuroradiology, CHU Kremlin Bicêtre, Paris, France. 16. Department of Neurology, CHU Kremlin Bicêtre, Paris, France. 17. Department of Neurology, CHU Caen, Caen, France. 18. Neuroradiology, CHU Caen, Caen, France. 19. Neuroradiology, CHU Limoges, Limoges, France. 20. Department of Neurology, CHU Limoges, Limoges, France. 21. Department of Neurology, CHU Pitié-Salpétrière, Paris, France. 22. Neuroradiology, Hôpital Saint-Anne, Paris, France. 23. Department of Neurology, Hôpital Saint-Anne, Paris, France. 24. Department of Neurology, CHU Rouen, Rouen, France. 25. Neuroradiology, CHU Rouen, Rouen, France. 26. Department of Neurology, CHU Toulouse, Toulouse, France. 27. Neuroradiology, CHU Toulouse, Toulouse, France. 28. Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France. 29. Neurology, CHBA Bretagne Atlantique, Vannes, France. 30. Department of Neurology, CHU Strasbourg, Strasbourg, France. 31. Neuroradiology, CHU Strasbourg, Strasbourg, France. 32. Department of Neurology, CHU Brest, Brest, France. 33. Neuroradiology, CHU Brest, Brest, France. 34. Department of Neurology, CH Côte Basque, Bayonne, France. 35. Neuroradiology, CH Côte Basque, Bayonne, France. 36. Neurology, CHRU Gui de Chauliac, Montpellier, France. 37. CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, 54000, Nancy, France. 38. IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France.
Abstract
PURPOSE: To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice. METHODS: We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr. RESULTS: Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization (mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3-7.9; p 0.009). CONCLUSION: The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr predictor.
PURPOSE: To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice. METHODS: We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr. RESULTS: Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization (mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3-7.9; p 0.009). CONCLUSION: The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr predictor.
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Tudor G Jovin; Angel Chamorro; Erik Cobo; María A de Miquel; Carlos A Molina; Alex Rovira; Luis San Román; Joaquín Serena; Sonia Abilleira; Marc Ribó; Mònica Millán; Xabier Urra; Pere Cardona; Elena López-Cancio; Alejandro Tomasello; Carlos Castaño; Jordi Blasco; Lucía Aja; Laura Dorado; Helena Quesada; Marta Rubiera; María Hernandez-Pérez; Mayank Goyal; Andrew M Demchuk; Rüdiger von Kummer; Miquel Gallofré; Antoni Dávalos Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245