Role of Favorable Perfusion Imaging in Predicting the Outcome of Patients with Acute Ischemic Stroke due to Large Vessel Occlusion Undergoing Effective Thrombectomy: A Single-Center Study

Riccardo Di Iorio, Fabio Pilato, Iacopo Valente, Andrea Laurienzo, Simona Gaudino, Giovanni Frisullo, Paolo Profice, Simone Cottonaro, Andrea Alexandre, Pietro Caliandro, Roberta Morosetti, Emilio Lozupone, Francesco D'Argento, Alessandro Pedicelli, Cesare Colosimo, Paolo Calabresi, Giacomo Della Marca, Aldobrando Broccolini, Riccardo Di Iorio, Fabio Pilato, Iacopo Valente, Andrea Laurienzo, Simona Gaudino, Giovanni Frisullo, Paolo Profice, Simone Cottonaro, Andrea Alexandre, Pietro Caliandro, Roberta Morosetti, Emilio Lozupone, Francesco D'Argento, Alessandro Pedicelli, Cesare Colosimo, Paolo Calabresi, Giacomo Della Marca, Aldobrando Broccolini

Abstract

Introduction: We sought to verify the predicting role of a favorable profile on computed tomography perfusion (CTP) in the outcome of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing effective mechanical thrombectomy (MT).

Methods: We retrospectively enrolled 25 patients with AIS due to LVO and with a CTP study showing the presence of ischemic penumbra who underwent effective MT, regardless of the time of onset. The controls were 25 AIS patients with overlapping demographics and clinical and computed tomography angiography features at admission who had undergone successful MT within 6 h from onset and without a previous CTP study. The outcome measure was the modified Rankin Scale (mRS) score at 90 days.

Results: Sixty-four percent of the study patients had an mRS score of 0-1 at 90 days versus 12% of the control patients (p < 0.001). Patients of the study group had a more favorable distribution of disability scores (median mRS [IQR] score of 0 [0-2] vs. 2 [2-3]). Multivariate analysis showed that the selection of patients based on a favorable CTP study was strongly associated (p < 0.001) with a better neurological outcome.

Conclusions: In our small-sized and retrospective study, the presence of ischemic penumbra was associated with a better clinical outcome in patients with AIS due to LVO after MT. In the future, a larger and controlled study with similar criteria of enrollment is needed to further validate the role of CTP in patient selection for MT, regardless of the time from the onset of symptoms.

Keywords: Ischemic stroke; Modified Rankin Scale; Outcome; Perfusion CT; Thrombectomy.

Conflict of interest statement

The authors have nothing to disclose.

© 2021 The Author(s) Published by S. Karger AG, Basel.

Figures

Fig. 1
Fig. 1
a Flow diagram of patient selection. * Initial infarct volume ≤70 mL and a ratio of the volume of ischemic tissue to infarct volume ≥1.8. b–e Representative case of a study patient. Axial (b) and coronal (c) CTA multiplanar reconstruction demonstrating ICA terminus occlusion (arrowheads). CTP shows a large area of penumbra involving the right cerebral hemisphere (T9–25smax, d), with a relatively small ischemic core (T16–25smax, e).
Fig. 2
Fig. 2
Distribution of mRS scores at 90 days. Scores of 5 and 6 were aggregated into a single worst-outcome group. The percentage of patients with an mRS score of 0–1 was 64% in the study group, compared with 12% in the control group (p < 0.001).

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