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Subcortical infarcts on admission CTP predict poor outcome despite excellent reperfusion in delayed time windows

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

The effect of pretreatment infarct location on clinical outcome after successful mechanical thrombectomy is not understood. Our aim was to evaluate the association between computed tomography perfusion (CTP)-based ischemic core location and clinical outcome following excellent reperfusion in late time windows.

Methods

We retrospectively reviewed patients who underwent thrombectomy for acute anterior circulation large vessel occlusion in late time windows from October 2019 to June 2021 and enrolled 65 patients with visible ischemic core on admission CTP who had received excellent reperfusion (modified thrombolysis in cerebral infarction grade 2c/3). Poor outcome was defined as a modified Rankin scale score of 3–6 at 90 days. The ischemic core infarct territories were classified into the cortical and subcortical areas. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were used in this study.

Results

Of the 65 patients analyzed, 38 (58.5%) had a poor outcome. Multivariable logistic analysis showed that the subcortical infarcts (OR 11.75; 95% CI 1.79–77.32; P = 0.010) and their volume (OR 1.17; 95% CI 1.04–1.32; P = 0.011) were independently associated with poor outcome. The ROC curve indicated the capacity of the subcortical infarct involvement (areas under the curve (AUC) = 0.65; 95% CI, 0.53–0.77, P < 0.001) and subcortical infarct volume (AUC = 0.72; 95% CI, 0.60–0.83, P < 0.001) in predicting poor outcome accurately.

Conclusion

Subcortical infarcts and their volume on admission CTP are associated with poor outcome after excellent reperfusion in late time windows, rather than cortical infarcts.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. H Ni and Y Hang contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China

    Heng Ni, Yu Hang, Chen-Dong Wang, Zhen-Yu Jia, Hai-Bin Shi, Sheng Liu & Lin-Bo Zhao

Authors
  1. Heng Ni
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  2. Yu Hang
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  3. Chen-Dong Wang
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  4. Zhen-Yu Jia
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  5. Hai-Bin Shi
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  6. Sheng Liu
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  7. Lin-Bo Zhao
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Corresponding author

Correspondence to Lin-Bo Zhao.

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The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

Based on the retrospective study design, the requirement for patient informed consent for study inclusion was waived.

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S Liu and LB Zhao contributed equally to this work and are listed as co-corresponding authors.

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Ni, H., Hang, Y., Wang, CD. et al. Subcortical infarcts on admission CTP predict poor outcome despite excellent reperfusion in delayed time windows. Neuroradiology 65, 1247–1254 (2023). https://doi.org/10.1007/s00234-023-03172-3

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  • DOI: https://doi.org/10.1007/s00234-023-03172-3

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