Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke.
DWI reversal; Endovascular procedures; Magnetic resonance imaging; Mechanical thrombectomy; Stroke; Humans; Prospective Studies; Thrombectomy; Diffusion Magnetic Resonance Imaging/methods; Tomography, X-Ray Computed; Treatment Outcome; Retrospective Studies; Ischemic Stroke; Stroke/diagnostic imaging; Stroke/surgery; Brain Ischemia/diagnostic imaging; Brain Ischemia/surgery; Brain Ischemia; Diffusion Magnetic Resonance Imaging; Radiology, Nuclear Medicine and Imaging; Neurology (clinical)
Abstract :
[en] [en] 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.
Disciplines :
Neurology
Author, co-author :
Panni, Pietro ; Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy. panni.pietro@hsr.it
Lapergue, Bertrand; Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
Maïer, Benjamin; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
Finitsis, Stephanos; AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Clarençon, Frédéric; Department of Neuroradiology, CHU Pitié-Salpétrière, Paris, France
Richard, Sébastien; CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine, 54000, Nancy, France ; CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France
Marnat, Gaultier; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
Bourcier, Romain; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
Sibon, Igor; Neurology, University Hospital of Bordeaux, Bordeaux, France
Dargazanli, Cyril; Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
Blanc, Raphaël; Department of Neuroradiology, University Hospital of Nantes, Nantes, France
Consoli, Arturo; Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
Eugène, François; Department of Neuroradiology, University Hospital of Rennes, Rennes, France
Vannier, Stéphane; Neurology, University Hospital of Rennes, Rennes, France
Spelle, Laurent; Neuroradiology, CHU Kremlin Bicêtre, Paris, France
Denier, Christian; Department of Neurology, CHU Kremlin Bicêtre, Paris, France
Boulanger, Marion; Department of Neurology, CHU Caen, Caen, France
Gauberti, Maxime; Neuroradiology, CHU Caen, Caen, France
Saleme, Suzana; Neuroradiology, CHU Limoges, Limoges, France
Macian, Francisco; Department of Neurology, CHU Limoges, Limoges, France
Rosso, Charlotte; Department of Neurology, CHU Pitié-Salpétrière, Paris, France
Naggara, Olivier; Neuroradiology, Hôpital Saint-Anne, Paris, France
Turc, Guillaume; Department of Neurology, Hôpital Saint-Anne, Paris, France
Ozkul-Wermester, Ozlem; Department of Neurology, CHU Rouen, Rouen, France
Papagiannaki, Chrisanthi; Neuroradiology, CHU Rouen, Rouen, France
Albucher, Jean-François; Department of Neurology, CHU Toulouse, Toulouse, France
Darcourt, Jean; Neuroradiology, CHU Toulouse, Toulouse, France
Le Bras, Anthony; Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France
Evain, Sarah; Neurology, CHBA Bretagne Atlantique, Vannes, France
Wolff, Valérie; Department of Neurology, CHU Strasbourg, Strasbourg, France
Pop, Raoul; Neuroradiology, CHU Strasbourg, Strasbourg, France
Timsit, Serge; Department of Neurology, CHU Brest, Brest, France
Gentric, Jean-Christophe; Neuroradiology, CHU Brest, Brest, France
Bourdain, Frédéric; Department of Neurology, CH Côte Basque, Bayonne, France
Veunac, Louis; Neuroradiology, CH Côte Basque, Bayonne, France
Arquizan, Caroline; Neurology, CHRU Gui de Chauliac, Montpellier, France
Gory, Benjamin; CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, 54000, Nancy, France ; IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France
ETIS (Endovascular Treatment in Ischemic Stroke) investigators
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques
Language :
English
Title :
Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke.
Publication date :
December 2022
Journal title :
Clinical Neuroradiology
ISSN :
1869-1439
eISSN :
1869-1447
Publisher :
Springer Science and Business Media Deutschland GmbH, Germany
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