Abstract
Background: Favorable clinical outcomes after acute ischemic stroke (AIS) in the setting of a symptomatic large vessel occlusion (LVO) are reliant upon fast and high quality recanalization. Recent data suggests that modified first pass effect mFPE (mTICI ≥ 2b after one attempt of thrombectomy) is a strong predictor of favorable outcome; however, the patient specific features that favor mFPE are poorly understood. In this study, we aim to understand the rate of mFPE in fast versus slow progressors of early infarct growth before recanalization. Methods: A retrospective review of all patients presenting with AIS due to LVO treated with endovascular thrombectomy (ET) at a single comprehensive stroke center between November 2014 and February 2017 was performed. The following data was collected: patient demographic features, imaging characteristics and procedural details (mTICI, thrombectomy attempts). Ischemic core volume before ET was analyzed using automated software (RAPID, IschemaView, Inc). Patients were stratified based on infarct growth and defined as follows: fast progressor (last known well-LKW <6 hours, core >50ml), slow progressors (LKW >6hours, core <30 ml), and intermediate progressor. Chi-square and student t-test were utilized to compare different groups. Results: Of 98 patients with available baseline core imaging, 8% (n=8) were fast progressors, 42% (n=41) were slow progressors, and the remaining 50% were intermediate progressors (n=49). mFPE rates were significantly higher in slow progressors compared to fast progressors (p = 0.02). Rates of successful recanalization (mTICI ≥ 2b) were lower in fast progressors compared to the slow and intermediate progressors (p = 0.073). Conclusion: Higher rates of successful recanalization and mFPE were observed in slow progressors of infarct growth. These results indicate that early recognition of LVO stroke phenotypes may aid in future device and technique selection for ET.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
