AUTHOR=Koopman Miou S. , Hoving Jan W. , Kappelhof Manon , Berkhemer Olvert A. , Beenen Ludo F. M. , van Zwam Wim H. , de Jong Hugo W. A. M. , Dankbaar Jan Willem , Dippel Diederik W. J. , Coutinho Jonathan M. , Marquering Henk A. , Emmer Bart J. , Majoie Charles B. L. M. , for the MR CLEAN Registry Investigators , Dippel Diederik W. J. , Lugt Aad van der , Majoie Charles B. L. M. , Roos Yvo B. W. E. M. , Oostenbrugge Robert J. van , Zwam Wim H. van , Boiten Jelis , Vos Jan Albert , Jansen Ivo G. H. , Mulder Maxim J. H. L. , Goldhoorn Robert-Jan B. , Compagne Kars C. J. , Kappelhof Manon , Brouwer Josje , Hartog Sanne J. den , Hinsenveld Wouter H. , Roozenbeek Bob , Lugt Aad van der , Es Adriaan C. G. M. van , Emmer Bart J. , Coutinho Jonathan M. , Schonewille Wouter J. , Wermer Marieke J. H. , Walderveen Marianne A. A. van , Staals Julie , Hofmeijer Jeannette , Martens Jasper M. , Nijeholt Geert J. Lycklama à , Bruijn Sebastiaan F. de , Dijk Lukas C. van , Worp H. Bart van der , Lo Rob H. , Dijk Ewoud J. van , Boogaarts Hieronymus D. , Vries J. de , Kort Paul L. M. de , Tuijl Julia van , Peluso Jo P. , Fransen Puck , Berg Jan S. P. van den , Hasselt Boudewijn A. A. M. van , Aerden Leo A. M. , Dallinga René J. , Uyttenboogaart Maarten , Eschgi Omid , Bokkers Reinoud P.H. , Schreuder Tobien H. C. M. L. , Heijboer Roel J. J. , Keizer Koos , Yo Lonneke S. F. , Hertog Heleen M. den , Sturm Emiel J. C. , Brouwers Paul J. A. M. , Sprengers Marieke E. S. , Jenniskens Sjoerd F. M. , Berg René van den , Yoo Albert J. , Beenen Ludo F. M. , Postma Alida A. , Roosendaal Stefan D. , Kallen Bas F. W. van der , Wijngaard Ido R. van den , Yo Lonneke S. F. , Bot Joost , Doormaal Pieter-Jan van , Meijer Anton , Ghariq Elyas , Bokkers Reinoud P. H. , Proosdij Marc P. van , Krietemeijer G. Menno , Peluso Jo P. , Lo Rob , Gerrits Dick , Dinkelaar Wouter , Appelman Auke P. A. , Hammer Bas , Pegge Sjoert , Hoorn Anouk van der , Vinke Saman , Oostenbrugge Robert J. van , Flach H. Zwenneke , Lingsma Hester F. , Ghannouti Naziha el , Sterrenberg Martin , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , Meris Joke de , Vermeulen Tamara , Geerlings Annet , Vemde Gina van , Simons Tiny , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Aaldering Nicoline , Zweedijk Berber , Vervoort Jocova , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Barning Denn , Venema Esmee , Chalos Vicky , Geuskens Ralph R. , Straaten Tim van , Ergezen Saliha , Muijres Roger R. M. Harmsma Daan , Jong Anouk de , Boers Anna M. M. , Huguet J. , Groot P. F. C. , Mens Marieke A. , Kranendonk Katinka R. van , Treurniet Kilian M. , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L. F. , Schupp Lieve M. , Voogd Eva J. H. F. , Collette Sabine , Groot Adrien E. D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Terreros Nerea Arrarte- , Ramos Lucas A.
TITLE=Association of Ischemic Core Imaging Biomarkers With Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry
JOURNAL=Frontiers in Neurology
VOLUME=12
YEAR=2022
URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.771367
DOI=10.3389/fneur.2021.771367
ISSN=1664-2295
ABSTRACT=Background: A considerable proportion of acute ischemic stroke patients treated with endovascular thrombectomy (EVT) are dead or severely disabled at 3 months despite successful reperfusion. Ischemic core imaging biomarkers may help to identify patients who are more likely to have a poor outcome after endovascular thrombectomy (EVT) despite successful reperfusion. We studied the association of CT perfusion-(CTP), CT angiography-(CTA), and non-contrast CT-(NCCT) based imaging markers with poor outcome in patients who underwent EVT in daily clinical practice.
Methods: We included EVT-treated patients (July 2016–November 2017) with an anterior circulation occlusion from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry with available baseline CTP, CTA, and NCCT. We used multivariable binary and ordinal logistic regression to analyze the association of CTP ischemic core volume, CTA-Collateral Score (CTA-CS), and Alberta Stroke Program Early CT Score (ASPECTS) with poor outcome (modified Rankin Scale score (mRS) 5-6) and likelihood of having a lower score on the mRS at 90 days.
Results: In 201 patients, median core volume was 13 (IQR 5-41) mL. Median ASPECTS was 9 (IQR 8-10). Most patients had grade 2 (83/201; 42%) or grade 3 (28/201; 14%) collaterals. CTP ischemic core volume was associated with poor outcome [aOR per 10 mL 1.02 (95%CI 1.01–1.04)] and lower likelihood of having a lower score on the mRS at 90 days [aOR per 10 mL 0.85 (95% CI 0.78–0.93)]. In multivariable analysis, neither CTA-CS nor ASPECTS were significantly associated with poor outcome or the likelihood of having a lower mRS.
Conclusion: In our population of patients treated with EVT in daily clinical practice, CTP ischemic core volume is associated with poor outcome and lower likelihood of shift toward better outcome in contrast to either CTA-CS or ASPECTS.