O09/90 Thrombectomy in ischemic stroke patients with large core but minor or absent ischemic changes on non-enhanced computed tomography

Introduction

ASPECTS and penumbral imaging based on CT-perfusion (CTP) are regularly used to guide patient selection for mechanical thrombectomy (MT). Yet, patients with large ischemic core on CTP may show no or only minor ischemic changes resulting in a high ASPECTS.

Aim

We hypothesized two-fold that vessel recanalization in patients with core volume >50 ml but ASPECTS≥6 is associated with better functional outcome and core overestimation.

Methods

Observational study analyzing ischemic stroke patients consecutively treated by MT after triage by multimodal-CT. Primary endpoint was the rate of functional independence at 90-days (mRS≤2). Secondary end point was core overestimation, which was considered when CTP-derived core was larger than final infarct volume assessed on follow-up. Multivariable logistic regression analysis and prospensity score matching (PSM) were used to assess the association of treatment with functional outcome and core overestimation.

Results

Of 630 patients with ASPECTS≥6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS≥6 (+25.8%,95%CI:16.3–35.4,p<0.001) compared to patients with ASPECTS≥6 and core volume <50 ml (+14.9%,95%CI:5.7–24.1,p=0.002). Recanalization (aOR:3.87,95%CI:1.66–9.00,p=0.002) and higher core volume (aOR:1.04,95%CI:1.02–1.05,p<0.001) were significantly associated with core overestimation.

Conclusion

In patients with ASPECTS≥6, core volumes did not significantly modify the treatment effect of recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with large ischemic core but minor ischemic changes on NECT.

Disclosure of Interest

NA.