MRI patient selection for endovascular thrombectomy in acute ischemic stroke: correlation between pretreatment diffusion weighted imaging and outcome scores

  • Marcello Longo
  • Gianmarco Bernava
  • Alessandro Calamuneri
  • Antonio A. Caragliano
  • Antonio Pitrone
  • Rosario Papa
  • Enricomaria Mormina
  • Francesca Granata
  • Rosa Musolino
  • Agostino Tessitore
  • Giuseppe Centorrino
  • Federico Midiri
  • Federica Vernuccio
  • Sergio L. Vinci
COMPUTED TOMOGRAPHY
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Abstract

Introduction

Eligibility for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) depends, amongst other factors, on CT- or MR-based scores. The aim of this study was to investigate the role of Alberta Stroke Program Early CT score based on diffusion weighted imaging (MR-ASPECT) in the assessment of brain damage pre-EVT, patient selection for EVT and outcome.

Materials and methods

We included in this study patients with National Institute of Health stroke score (NIHSS) at admission ≥ 8, MR-ASPECT ≥ 5 and anterior AIS, who were treated with EVT in our hospital. All patients were clinically evaluated at admission, post-EVT, discharge and at 3-month follow-up. We used MR-ASPECT to establish infarct core extension at admission. We evaluated ASPECT score at admission (CT-ASPECT-IN), 24 h after EVT and at discharge, NIHSS, modified Ranking Scale (mRS), Thrombolysis in Cerebral Infarction scale (TICI), onset-to-intervention-delay (OTID) and Collateral Circulation Score (CCS).

Results

68 patients (mean age 78 ± 11.9 years) were included in this study. 54.4 and 64.7% of patients had strong clinical improvement after 24 h from EVT and at discharge, respectively. NIHSS evaluated 24 h after EVT correlated with CCS, TICI and OTID. We observed a favourable outcome (mRS 0–2) in 52.9% of patients at 3-month follow-up. MR-ASPECT score correlated with post-EVT outcome better than CT-ASPECT-IN scores.

Conclusion

MR-ASPECT score based on diffusion weighted imaging is useful for the selection of patients with AIS that can have a favourable outcome from EVT. A prompt EVT has huge impact on patient outcome.

Keywords

Stroke Diffusion weighted imaging Revascularization Magnetic resonance 

Notes

Compliance with ethical standards

Conflict of interest

Antonio Pitrone declares UNRELATED conflict of interest: Consultancy: Medtronic. Rosario Papa declares UNRELATED conflict of interest: Consultancy: Medtronic. Marcello Longo declares UNRELATED conflict of interest: Consultancy: Medtronic. Sergio L. Vinci declares UNRELATED conflict of interest: Consultancy: Medtronic. Gianmarco Bernava declares that he has no conflict of interest. Alessandro Calamuneri declares that he has no conflict of interest. Antonio A. Caragliano declares that he has no conflict of interest. Enricomaria Mormina declares that he has no conflict of interest. Francesca Granata declares that she has no conflict of interest. Rosa Musolino declares that she has no conflict of interest. Agostino Tessitore declares that he has no conflict of interest. Giuseppe Centorrino declares that he has no conflict of interest. Federico Midiri declares that he has no conflict of interest. Federica Vernuccio declares that she has no conflict of interest.

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

Informed consent was waived in accordance with the clinical condition of the patient and the protocol was approved by the Ethical Committee.

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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  • Marcello Longo
    • 1
  • Gianmarco Bernava
    • 1
  • Alessandro Calamuneri
    • 2
  • Antonio A. Caragliano
    • 1
  • Antonio Pitrone
    • 1
  • Rosario Papa
    • 1
  • Enricomaria Mormina
    • 2
  • Francesca Granata
    • 1
  • Rosa Musolino
    • 3
  • Agostino Tessitore
    • 1
  • Giuseppe Centorrino
    • 1
  • Federico Midiri
    • 4
  • Federica Vernuccio
    • 4
  • Sergio L. Vinci
    • 1
  1. 1.Neuroradiology Unit - Department of Biomedical Sciences and of Morphologic and Functional ImagesUniversity of MessinaMessinaItaly
  2. 2.Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  3. 3.Stroke Unit - Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  4. 4.Radiology Section - DIBIMEDUniversity Hospital “Paolo Giaccone”, University of PalermoPalermoItaly

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