Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion-weighted imaging lesions
- 1 October 2020
- journal article
- research article
- Published by Wiley in European Journal of Neurology
- Vol. 27 (10), 1988-1995
- https://doi.org/10.1111/ene.14330
Abstract
Background and purpose Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. Methods Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were 15, baseline Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score <= 6 and baseline diffusion-weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score >= 2b. Occurrence of MMI was the primary endpoint. Results A total of 66 EVT-treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%;P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%;P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10-1.12) for MMI and 2.77 (0.84-10.43) for 3-month favorable outcome occurrence. Conclusions Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI.This publication has 16 references indexed in Scilit:
- Acute Stroke With Large Ischemic Core Treated by ThrombectomyStroke, 2019
- European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE)European Stroke Journal, 2019
- 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke AssociationStroke, 2018
- Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) ScoreStroke, 2017
- Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in StrokeThe New England Journal of Medicine, 2015
- Complications Associated with Decompressive Craniectomy: A Systematic ReviewNeurocritical Care, 2015
- Recommendations for the Management of Cerebral and Cerebellar Infarction With SwellingStroke, 2014
- Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational studyAnnals of Neurology, 2010
- Pretreatment ASPECTS on DWI predicts 3-month outcome following rt-PANeurology, 2010
- Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trialsThe Lancet Neurology, 2007