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Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy.
Yedavalli, Vivek; Salim, Hamza Adel; Musmar, Basel; Adeeb, Nimer; El Naamani, Kareem; Henninger, Nils; Sundararajan, Sri Hari; Kühn, Anna Luisa; Khalife, Jane; Ghozy, Sherief; Scarcia, Luca; Tan, Benjamin Yq; Regenhardt, Robert W; Heit, Jeremy J; Cancelliere, Nicole M; Bernstock, Joshua D; Rouchaud, Aymeric; Fiehler, Jens; Sheth, Sunil; Puri, Ajit S; Dyzmann, Christian; Colasurdo, Marco; Barreau, Xavier; Renieri, Leonardo; Filipe, João Pedro; Harker, Pablo; Radu, Razvan Alexandru; Abdalkader, Mohamad; Klein, Piers; Marotta, Thomas R; Spears, Julian; Ota, Takahiro; Mowla, Ashkan; Jabbour, Pascal; Biswas, Arundhati; Clarençon, Frédéric; Siegler, James E; Nguyen, Thanh N; Varela, Ricardo; Baker, Amanda; Essibayi, Muhammed Amir; Altschul, David; Gonzalez, Nestor R; Möhlenbruch, Markus A; Costalat, Vincent; Gory, Benjamin; Stracke, Christian Paul; Aziz-Sultan, Mohammad Ali; Hecker, Constantin; Shaikh, Hamza.
Afiliación
  • Yedavalli V; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
  • Salim HA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
  • Musmar B; Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Adeeb N; Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA.
  • El Naamani K; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA.
  • Henninger N; Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA, USA.
  • Sundararajan SH; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
  • Kühn AL; Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
  • Khalife J; Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, NJ, USA.
  • Ghozy S; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
  • Scarcia L; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
  • Tan BY; Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
  • Regenhardt RW; Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
  • Heit JJ; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Cancelliere NM; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
  • Bernstock JD; Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Rouchaud A; Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
  • Fiehler J; Divisions of Therapeutic Neuroradiology and Neurosurgery, Neurovascular Centre, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Sheth S; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Puri AS; Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR, France.
  • Dyzmann C; Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
  • Colasurdo M; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Barreau X; Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
  • Renieri L; Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
  • Filipe JP; Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
  • Harker P; Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
  • Radu RA; Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
  • Abdalkader M; Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
  • Klein P; Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
  • Marotta TR; Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
  • Spears J; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France.
  • Ota T; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
  • Mowla A; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
  • Jabbour P; Divisions of Therapeutic Neuroradiology and Neurosurgery, Neurovascular Centre, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Biswas A; Divisions of Therapeutic Neuroradiology and Neurosurgery, Neurovascular Centre, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
  • Clarençon F; Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
  • Siegler JE; Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
  • Nguyen TN; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
  • Varela R; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
  • Baker A; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
  • Essibayi MA; GRC BioFast., Sorbonne University, Paris VI, France.
  • Altschul D; Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
  • Gonzalez NR; Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
  • Möhlenbruch MA; Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
  • Costalat V; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Gory B; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Stracke CP; Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
  • Aziz-Sultan MA; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
  • Hecker C; Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
  • Shaikh H; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France.
Eur Stroke J ; : 23969873241275531, 2024 Sep 13.
Article en En | MEDLINE | ID: mdl-39269154
ABSTRACT

BACKGROUND:

Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT.

METHODS:

This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT.

RESULTS:

Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes.

CONCLUSIONS:

FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Stroke J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Stroke J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido