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CardioVascular and Interventional Radiology

, Volume 40, Issue 4, pp 502–509 | Cite as

Low Cerebral Blood Volume Identifies Poor Outcome in Stent Retriever Thrombectomy

  • Sara ProttoEmail author
  • Juha-Pekka Pienimäki
  • Janne Seppänen
  • Heikki Numminen
  • Niko Sillanpää
Clinical Investigation

Abstract

Background

Mechanical thrombectomy (MT) is an efficient treatment of acute stroke caused by large-vessel occlusion. We evaluated the factors predicting poor clinical outcome (3-month modified Rankin Scale, mRS >2) although MT performed with modern stent retrievers.

Methods

We prospectively collected the clinical and imaging data of 105 consecutive anterior circulation stroke patients who underwent MT after multimodal CT imaging. Patients with occlusion of the internal carotid artery and/or middle cerebral artery up to the M2 segment were included. We recorded baseline clinical, procedural and imaging variables, technical outcome, 24-h imaging outcome and the clinical outcome. Differences between the groups were studied with appropriate statistical tests and binary logistic regression analysis.

Results

Low cerebral blood volume Alberta stroke program early CT score (CBV-ASPECTS) was associated with poor clinical outcome (median 7 vs. 9, p = 0.01). Lower collateral score (CS) significantly predicted poor outcome in regression modelling with CS = 0 increasing the odds of poor outcome 4.4-fold compared to CS = 3 (95% CI 1.27–15.5, p = 0.02). Lower CBV-ASPECTS significantly predicted poor clinical outcome among those with moderate or severe stroke (OR 0.82, 95% CI 0.68–1, p = 0.05) or poor collateral circulation (CS 0–1, OR 0.66, 95% CI 0.48–0.90, p = 0.009) but not among those with mild strokes or good collaterals.

Conclusions

CBV-ASPECTS estimating infarct core is a significant predictor of poor clinical outcome among anterior circulation stroke patients treated with MT, especially in the setting of poor collateral circulation and/or moderate or severe stroke.

Keywords

Interventional radiology Ischemic stroke Mechanical thrombectomy Perfusion CT 

Abbreviations

ASPECTS

Alberta stroke program early CT score

CBV

Cerebral blood volume

COED

Cerebral oedema

CS

Collateral score

ICA

Internal carotid artery

IVT

Intravenous thrombolysis

MCA

Middle cerebral artery

MT

Mechanical thrombectomy

MTT

Mean transit time

NIHSS

National Institutes of Health Stroke Scale

TICI

Thrombolysis in cerebral infarction

Notes

Compliance with Ethical Standards

Conflict of interest

No conflict of interest for all authors.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

270_2016_1532_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  1. 1.Medical Imaging CenterTampere University HospitalTampereFinland
  2. 2.Department of NeurologyTampere University HospitalTampereFinland

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