Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy

Alessandro Davoli, Caterina Motta, Giacomo Koch, Marina Diomedi, Simone Napolitano, Angela Giordano, Marta Panella, Daniele Morosetti, Sebastiano Fabiano, Roberto Floris, Roberto Gandini, Fabrizio Sallustio

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.

METHODS: Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.

RESULTS: 98 patients were included in the analysis, 35 of whom developed MMI (35.7%). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46%; specificity 97%; positive predictive value 78%; negative predictive value 65%).

CONCLUSIONS: in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.

Original languageEnglish
JournalJournal of NeuroInterventional Surgery
DOIs
Publication statusE-pub ahead of print - Aug 10 2017

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Thrombectomy
Stroke
Alberta
Reperfusion
Blood Pressure
Blood Glucose
Therapeutics
Middle Cerebral Artery Infarction
Multivariate Analysis
Regression Analysis
Demography
Databases
Hypertension
Research

Keywords

  • Journal Article

Cite this

Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy. / Davoli, Alessandro; Motta, Caterina; Koch, Giacomo; Diomedi, Marina; Napolitano, Simone; Giordano, Angela; Panella, Marta; Morosetti, Daniele; Fabiano, Sebastiano; Floris, Roberto; Gandini, Roberto; Sallustio, Fabrizio.

In: Journal of NeuroInterventional Surgery, 10.08.2017.

Research output: Contribution to journalArticle

Davoli, Alessandro ; Motta, Caterina ; Koch, Giacomo ; Diomedi, Marina ; Napolitano, Simone ; Giordano, Angela ; Panella, Marta ; Morosetti, Daniele ; Fabiano, Sebastiano ; Floris, Roberto ; Gandini, Roberto ; Sallustio, Fabrizio. / Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy. In: Journal of NeuroInterventional Surgery. 2017.
@article{9982e459f8914acab30ea46782dde4ea,
title = "Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy",
abstract = "BACKGROUND: Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.METHODS: Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.RESULTS: 98 patients were included in the analysis, 35 of whom developed MMI (35.7{\%}). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46{\%}; specificity 97{\%}; positive predictive value 78{\%}; negative predictive value 65{\%}).CONCLUSIONS: in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.",
keywords = "Journal Article",
author = "Alessandro Davoli and Caterina Motta and Giacomo Koch and Marina Diomedi and Simone Napolitano and Angela Giordano and Marta Panella and Daniele Morosetti and Sebastiano Fabiano and Roberto Floris and Roberto Gandini and Fabrizio Sallustio",
note = "{\circledC} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",
year = "2017",
month = "8",
day = "10",
doi = "10.1136/neurintsurg-2017-013224",
language = "English",
journal = "Journal of NeuroInterventional Surgery",
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T1 - Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy

AU - Davoli, Alessandro

AU - Motta, Caterina

AU - Koch, Giacomo

AU - Diomedi, Marina

AU - Napolitano, Simone

AU - Giordano, Angela

AU - Panella, Marta

AU - Morosetti, Daniele

AU - Fabiano, Sebastiano

AU - Floris, Roberto

AU - Gandini, Roberto

AU - Sallustio, Fabrizio

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2017/8/10

Y1 - 2017/8/10

N2 - BACKGROUND: Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.METHODS: Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.RESULTS: 98 patients were included in the analysis, 35 of whom developed MMI (35.7%). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46%; specificity 97%; positive predictive value 78%; negative predictive value 65%).CONCLUSIONS: in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.

AB - BACKGROUND: Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.METHODS: Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.RESULTS: 98 patients were included in the analysis, 35 of whom developed MMI (35.7%). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46%; specificity 97%; positive predictive value 78%; negative predictive value 65%).CONCLUSIONS: in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.

KW - Journal Article

U2 - 10.1136/neurintsurg-2017-013224

DO - 10.1136/neurintsurg-2017-013224

M3 - Article

C2 - 28798267

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

ER -