Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy

Vivek Yedavalli; Hamza Adel Salim; Basel Musmar; Nimer Adeeb; Kareem El Naamani; Nils Henninger; Sri Hari Sundararajan; Anna Luisa Kühn; Jane Khalife; Sherief Ghozy; Luca Scarcia; Benjamin Yq Tan; Robert W Regenhardt; Jeremy J Heit; Nicole M Cancelliere; Joshua D Bernstock; Aymeric Rouchaud; Jens Fiehler; Sunil Sheth; Ajit S Puri; Christian Dyzmann; Marco Colasurdo; Xavier Barreau; Leonardo Renieri; João Pedro Filipe; Pablo Harker; Răzvan Alexandru Radu; Mohamad Abdalkader; Piers Klein; Thomas R Marotta; Julian Spears; Takahiro Ota; Ashkan Mowla; Pascal Jabbour; Arundhati Biswas; Frédéric Clarençon; James E Siegler; Thanh N Nguyen; Ricardo Varela; Amanda Baker; Muhammed Amir Essibayi; David Altschul; Nestor R Gonzalez; Markus A Möhlenbruch; Vincent Costalat; Benjamin Gory; Christian Paul Stracke; Mohammad Ali Aziz-Sultan; Constantin Hecker; Hamza Shaikh; David S Liebeskind; Alessandro Pedicelli; Andrea M Alexandre; Illario Tancredi; Tobias D Faizy; Erwah Kalsoum; Boris Lubicz; Aman B Patel; Vitor Mendes Pereira; Adrien Guenego; Adam A Dmytriw; MAD MT Investigators

doi:10.1177/23969873241275531

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Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy

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Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy

Vivek Yedavalli, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, …

European stroke journal, Vol.10(2), pp.431-441

01/06/2025

DOI: https://doi.org/10.1177/23969873241275531

PMID: 39269154

Résumé

Aged

Aged, 80 and over

Cohort Studies

Female

Follow-Up Studies

Humans

Infarction, Middle Cerebral Artery - diagnostic imaging

Infarction, Middle Cerebral Artery - pathology

Infarction, Middle Cerebral Artery - surgery

Ischemic Stroke - surgery

Male

Middle Aged

Predictive Value of Tests

Prognosis

Registries

Retrospective Studies

Thrombectomy - methods

Treatment Outcome

Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT. This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT. Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes. FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

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Titre: Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy
Créateurs - sans rôle: Vivek Yedavalli - Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
Hamza Adel Salim - Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA
Basel Musmar - Louisiana State University
Nimer Adeeb - Louisiana State University
Kareem El Naamani - Thomas Jefferson University
Nils Henninger - University of Massachusetts Chan Medical School
Sri Hari Sundararajan - Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, NJ, USA
Anna Luisa Kühn - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
Jane Khalife - Cooper University Hospital
Sherief Ghozy - Neurological Surgery
Luca Scarcia - Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
Benjamin Yq Tan - Division of Neurology, Department of Medicine, National University Hospital, Singapore
Robert W Regenhardt - Brigham and Women's Hospital
Jeremy J Heit - Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
Nicole M Cancelliere - University of Toronto
Joshua D Bernstock - Brigham and Women's Hospital
Aymeric Rouchaud - Neuroradiology Department, University Hospital of Limoges, Dupuytren, Université de Limoges, XLIM CNRS, UMR, France
Jens Fiehler - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Sunil Sheth - The University of Texas Health Science Center at Houston
Ajit S Puri - Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA
Christian Dyzmann - Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany
Marco Colasurdo - University of Portland
Xavier Barreau - Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
Leonardo Renieri - Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
João Pedro Filipe - Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Pablo Harker - University of Cincinnati Medical Center
Răzvan Alexandru Radu - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France
Mohamad Abdalkader - Boston Medical Center
Piers Klein - Boston Medical Center
Thomas R Marotta - University of Toronto
Julian Spears - Divisions of Therapeutic Neuroradiology and Neurosurgery, Neurovascular Centre, St. Michael Hospital, University of Toronto, Toronto, ON, Canada
Takahiro Ota - Tokyo Metropolitan Tama Medical Center
Ashkan Mowla - Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
Pascal Jabbour - Thomas Jefferson University
Arundhati Biswas - Westchester Medical Center
Frédéric Clarençon - GRC BioFast., Sorbonne University, Paris VI, France
James E Siegler - Cooper University Hospital
Thanh N Nguyen - Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA
Ricardo Varela - Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Amanda Baker - Albert Einstein College of Medicine
Muhammed Amir Essibayi - Albert Einstein College of Medicine
David Altschul - Albert Einstein College of Medicine
Nestor R Gonzalez - Cedars-Sinai Medical Center
Markus A Möhlenbruch - Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
Vincent Costalat - Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, France
Benjamin Gory - Université de Lorraine
Christian Paul Stracke - Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany
Mohammad Ali Aziz-Sultan - Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Constantin Hecker - Paracelsus Medical University
Hamza Shaikh - Cooper University Hospital
David S Liebeskind - Department of Neurology, UCLA Stroke Center, UCLA, Los Angeles, CA, USA
Alessandro Pedicelli - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy
Andrea M Alexandre - UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Roma, Italy
Illario Tancredi - Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
Tobias D Faizy - Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany
Erwah Kalsoum - Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
Boris Lubicz - Universitair Ziekenhuis Brussel
Aman B Patel - Brigham and Women's Hospital
Vitor Mendes Pereira - University of Toronto
Adrien Guenego - Universitair Ziekenhuis Brussel
Adam A Dmytriw - University of Toronto
MAD MT Investigators
Détails de publication: European stroke journal, Vol.10(2), pp.431-441
Note de subvention: R21 NS131756 / NINDS NIH HHS U24 NS113844 / NINDS NIH HHS R21 NR020231 / NINR NIH HHS
Identifiants: 99162998009311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article