Abstract T MP3: DWI Volume May Not Be a Single Stop Sign of Endovascular Revascularization Therapy for Acute Ischemic Stroke

Abstract

Background and purpose: This study was retrospectively designed to evaluate whether early huge DWI volume is a single ‘stop sign’ of intra-arterial (IA) therapy for acute ischemic stroke. Methods: Patients with acute ischemic stroke in anterior circulation territory and IA revascularization therapy were retrieved. DWI volume taken before the IA therapy was calculated with semiquantative method. Futile prognosis was defined as modified Rankin Scale 5-6 at 3 months. We divided patients into 4 groups. Group 1 represented with DWI volume less than 33.3 cm 3 , group 2 with 33.3 to 100 cm 3 , group 3 with 100 to 200 cm 3 and group 4 with more than 200 cm 3 . Baseline characteristics, imaging data and clinical outcomes were compared among groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were done. Results: Finally, 80 patients were enrolled in this study. Demographics and outcomes were described in Table 1. DWI volume more than 200 cm 3 was significantly associated with futile prognosis (Table 2). The area under the ROC curve for all DWI volumes was 0.686 (p=0.005). For predicting futile prognosis, sensitivity and specificity were 45.7% and 79.5% at DWI volume 100 cm 3 , and 31.4% and 97.7% at 200 cm 3 , respectively. Conclusions: A huge DWI volume was associated with the futile prognosis. This imaging marker, however, could not be a single sign for stopping further aggressive IA treatment for acute ischemic stroke because the area under the ROC curve was relatively small. When IA therapy is considered, well known harmful factors including old age, high NIHSS score and huge DWI volume should be combined altogether for ‘no more to go’.