J Korean Neurosurg Soc.  2022 Jan;65(1):22-29. 10.3340/jkns.2021.0064.

Outcomes of Mechanical Thrombectomy in Patients with Large Diffusion-Weighted Imaging Lesions

• Cho YH
• Choi JH

• KMID: 2523910
• DOI: http://doi.org/10.3340/jkns.2021.0064

Abstract

Objective
: Despite many advancements in endovascular treatment, the benefits of mechanical thrombectomy (MT) in patients with large infarctions remain uncertain due to hemorrhagic complications. Therefore, we aimed to investigate the efficacy and safety of recanalization via MT within 6 hours after stroke in patients with large cerebral infarction volumes (>70 mL).
Methods
: We retrospectively reviewed the medical data of 30 patients with large lesions on initial diffusion-weighted imaging (>70 mL) who underwent MT at our institution within 6 hours after stroke onset. Baseline data, recanalization rate, and 3-month clinical outcomes were analyzed. Successful recanalization was defined as a modified treatment in cerebral ischemia score of 2b or 3.
Results
: The recanalization rate was 63.3%, and symptomatic intracerebral hemorrhage occurred in six patients (20%). The proportion of patients with modified Rankin Scale (mRS) scores of 0–3 was significantly higher in the recanalization group than in the non-recanalization group (47.4% vs. 9.1%, p=0.049). The mortality rate was higher in the non-recanalization group, this difference was not significant (15.8% vs. 36.4%, p=0.372). In the analysis of 3-month clinical outcomes, only successful recanalization was significantly associated with mRS scores of 0–3 (90% vs. 50%, p=0.049). The odds ratio of recanalization for favorable outcomes (mRS 0–3) was 9.00 (95% confidence interval, 0.95–84.90; p=0.055).
Conclusion
: Despite the risk of symptomatic intracerebral hemorrhage, successful recanalization via MT 6 hours after stroke may improve clinical outcomes in patients with large vessel occlusion.

Keyword

Cerebral infarction; Ischemia; Mechanical thrombectomy; Stroke; Magnetic resonance imaging, diffusion weighted

Figure

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  Fig. 1. Study flow chart. DWI : diffusion-weighted imaging, OTP : onset to puncture time, mTICI : modified Treatment in Cerebral Ischemia.

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  Fig. 2. Functional outcome at 3 months according to the recanalization status in patients with diffusion-weighted imaging lesions >70 mL. Although the proportion of patients with modified Rankin Scale (mRS) scores of 0–2 was higher in the recanalization group than in the non-recanalization group, this difference did not reach statistical significance (21.1% vs. 0%, p=0.268). However, the proportion of patients with mRS scores of 0–3 was also higher in the recanalization group (47.4% vs. 9.1%), and the difference was statistically significant (p=0.049).

Reference

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