Abstract WP21: Successful Reperfusion With Thrombectomy in Patients With Large Dwi Lesion is Associated With Reduced Occurrence of Malignant Stroke

Abstract

Introduction: Malignant middle cerebral artery infarction (MMI) is a severe complication of ischaemic stroke (IS), with a mortality rate up to 80%. Diffusion-weighted imaging (DWI) lesion volume larger than 82 millilitres on cerebral MRI performed within the six first hours is known to be predictive of MMI. These patients, with “malignant profile”, were mostly excluded of endovascular therapy (EVT) randomised trials. The aim of our study was to evaluate whether successful reperfusion after EVT in patients presenting IS with large DWI lesion decreased occurrence of malignant stroke. Methods: We analysed data collected between 2014 and 2018, in a monocentric prospective IS patients registry treated with EVT. Patients were selected if they had a malignant profile and could be eligible to a craniectomy. Thus, selected patients were less than 65-years old, with a severe stroke defined by National Institutes of Health Stroke Scale (NIHSS) score > 15 and with DWI lesion larger than 82ml. We compared patients with successful recanalization (defined by Thrombolysis in Cerebral Ischemia (TICI) 2b or 3) and poor recanalization (TICI 0, 1 or 2A). Primary end point was malignant stroke rate. Secondary end points were craniectomy, haemorrhagic complications, 90-days all-cause mortality rates and 90-days favourable outcome (defined by modified Rankin Scale 0-2). Results: From 2014 to 2018, 66 patients were selected. MMI occurred in 27 patients (42%), and 22 (33%) had effectively craniectomy. Successful recanalization was observed for 46 patients (69.7%). MMI occurrence was significantly lower in the latter patients compared to the poor recanalization group (14/44(31.8%) vs 13/20(65.0%); OR=0.25 (0.08-0.77), p = 0.015). Less craniectomies were performed in the successful recanalization group (12/46 (26.1%) vs 10/20 (50.0%); OR=0.35 (011-1.06), p=0.063).There was no significant difference in symptomatic intracranial haemorrhage rate; in 90-days favourable outcome and all causes mortality rate between the two groups. Conclusion: Successful recanalization performed in IS patients with large DWI lesion decreases the occurrence of malignant strokes and the need for craniectomy procedure. Further data with a larger sample or from randomized studies are needed.