Abstract
Background: In patients with acute ischemic stroke involving the anterior circulation who undergo mechanical thrombectomy (MT), it is not known which, if any, measure of ischemic core volume (ASPECTS, CBF <30% volume, or Tmax >10 seconds volume) is best at predicting functional outcome as defined by 90-day mRS. This retrospective study investigated the relationship between measures of ischemic core volumes and functional outcomes and compared these to known outcome predictors including baseline NIHSS and thrombectomy reperfusion success (TICI) scores. Methods: We included 100 consecutive patients with ischemic stroke due to internal carotid artery or middle cerebral artery occlusion who underwent CT perfusion and were treated with MT. CBF <30% volumes and Tmax >10 s volumes were automatically estimated using RAPID software. ASPECTS were automatically scored using e-ASPECTS software. TICI scores were graded by the case interventionalist and neurologist. Pearson correlation coefficients (r) were calculated to evaluate relationships between each predictor variable (initial NIHSS, TICI score, ASPECTS, CBF <30% volume, and Tmax >10 s volume) and the dependent variable (90-day mRS). Results: As expected, there was a significant relationship between both baseline NIHSS and TICI score and 90-day mRS (NIHSS-mRS r=0.25, R 2 =0.063, p=0.01; TICI-mRS r=-0.28, R 2 =0.077, p=0.005). In contrast, all measures of ischemic core volume had very low, non-significant correlations with 90-day mRS (ASPECTS-mRS r=-0.057, R 2 =0.0032, p=0.6; CBF <30% volume-mRS r=0.0042, R 2 =0, p=0.9; Tmax >10 s volume-mRS r=-0.020, R 2 = 0.0004, p=0.9). Conclusions: Initial stroke severity and MT success remain the best predictors of functional outcomes in patients undergoing MT. None of the assessed markers of ischemic core volume predicted functional outcomes. These results only apply to thrombectomy patients and not to cases excluded by larger cores.
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