The role of infarct location in patients with DWI-ASPECTS 0–5 acute stroke treated with thrombectomy
Pietro Panni
(1, 2, 3)
,
Caterina Michelozzi
(1, 2, 3)
,
Raphael Blanc
(4, 2, 3)
,
Bailiang Chen
(5, 2, 3)
,
Arturo Consoli
(3, 5, 2)
,
Mikael Mazighi
(4, 2, 3)
,
Michel Piotin
(4, 2, 3)
,
Cyril Dargazanli
(6, 2, 3)
,
Caroline Arquizan
(7, 2, 3)
,
Gaultier Marnat
(8, 2, 3)
,
Igor Sibon
(9, 2, 3)
,
René Anxionnat
(5, 10, 2, 3)
,
Sébastien Richard
(11, 12, 2, 3)
,
Gabriela Hossu
(5, 13, 2, 3)
,
Romain Bourcier
(14, 2, 3)
,
Bertrand Lapergue
(3, 2)
,
Benjamin Gory
(5, 10, 2, 3)
1
UniSR -
Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
2 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
3 Hôpital Foch [Suresnes]
4 Fondation Ophtalmologique Adolphe de Rothschild [Paris]
5 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
6 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
7 Département de neurologie [Montpellier]
8 DNR - Bordeaux - Département de Neuro-Radiologie [Bordeaux]
9 Hôpital Haut-Lévêque [CHU Bordeaux]
10 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
11 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
12 Service de Cardiologie [CHRU Nancy]
13 CIC-IT - Centre d'Investigation Clinique - Innovation Technologique [Nancy]
14 CHU Nantes - Centre Hospitalier Universitaire de Nantes
2 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
3 Hôpital Foch [Suresnes]
4 Fondation Ophtalmologique Adolphe de Rothschild [Paris]
5 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
6 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
7 Département de neurologie [Montpellier]
8 DNR - Bordeaux - Département de Neuro-Radiologie [Bordeaux]
9 Hôpital Haut-Lévêque [CHU Bordeaux]
10 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
11 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
12 Service de Cardiologie [CHRU Nancy]
13 CIC-IT - Centre d'Investigation Clinique - Innovation Technologique [Nancy]
14 CHU Nantes - Centre Hospitalier Universitaire de Nantes
Raphael Blanc
- Fonction : Auteur
- PersonId : 767098
- ORCID : 0000-0002-3975-3865
- IdRef : 074484559
Mikael Mazighi
- Fonction : Auteur
- PersonId : 786644
- ORCID : 0000-0003-0911-8999
- IdRef : 069189781
Michel Piotin
- Fonction : Auteur
- PersonId : 767048
- ORCID : 0000-0002-1354-4328
- IdRef : 104505605
Cyril Dargazanli
- Fonction : Auteur
- PersonId : 786393
- ORCID : 0000-0003-1891-9157
- IdRef : 150524501
Gaultier Marnat
- Fonction : Auteur
- PersonId : 791791
- ORCID : 0000-0002-7611-7753
Igor Sibon
- Fonction : Auteur
- PersonId : 758274
- ORCID : 0000-0002-1171-4215
René Anxionnat
- Fonction : Auteur
- PersonId : 755707
- ORCID : 0000-0001-6112-0661
- IdRef : 075878445
Gabriela Hossu
- Fonction : Auteur
- PersonId : 746470
- IdHAL : gabriela-hossu
- ORCID : 0000-0003-1178-9097
- IdRef : 140763341
Benjamin Gory
- Fonction : Auteur
- PersonId : 762859
- ORCID : 0000-0001-8424-4464
Résumé
Objective To determine whether hemisphere involvement and infarct location on the Alberta Stroke Program CT Score (ASPECTS) template should serve as predictors of 90-day clinical outcome in patients with acute ischemic stroke with pretreatment diffusion-weighted imaging (DWI)–ASPECTS 0–5 treated with mechanical thrombectomy (MT). Methods We analyzed data of all consecutive patients included in the Endovascular Treatment in Ischemic Stroke registry between January 1, 2012, and August 31, 2018, who presented with a pretreatment DWI-ASPECTS 0–5 and underwent MT. Multivariable analyses were performed in order to identify the role of infarct location and hemisphere involvement on good outcome defined by a modified Rankin Scale (mRS) score 0–2 at 90 days and on the whole distribution of mRS (shift analysis). Results A total of 344 patients with a DWI-ASPECTS 0–5 (median 4, IQR 3–5) were included. Neither infarct location nor hemisphere involvement was found to be an independent predictor of good outcome. Involvement of the M6 region in right-sided strokes (adjusted odds ratio [aOR] 2.6, 99% confidence interval [CI] 1.14–5.8; p = 0.003) and the internal capsule in left-sided strokes (aOR 2.6, 99% CI 0.8–7.9; p < 0.020) independently predicted increased disability on the mRS distribution in the affected subpopulations. Conclusion Our study suggests that neither hemisphere nor infarct location should be considered as an exclusion criterion for MT in patients with stroke with pretreatment DWI-ASPECTS 0–5. The involvement of specific regions of interest was associated with increased disability. These may provide valuable information regarding stroke management options and neurologic recovery for use of caregivers in the postacute phase.