Mechanical thrombectomy for acute large-vessel occlusion with large early ischemic change

Abstract

  We report the outcomes of mechanical thrombectomy (MT) for acute large‒vessel occlusions with a large diffusion‒weighted imaging (DWI) lesion. Of the 127 patients who underwent MT during the 3‒year period from April 2016 to March 2019 at our hospital, the study subjects were 101 patients with an arterial occlusion involving the major arteries of the cerebral anterior circulation. We divided the patients into two groups based on their DWI‒Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≤ 5 or ＞ 6 and retrospectively analyzed the two groups’ outcomes. A thrombolysis in cerebral infarction (TICI) grade 2b‒3 was achieved in 62% of the patients in the DWI‒ASPECTS ≤ 5 group and 88% of those in the DWI ASPECTS ＞ 6 group (p=0.004). A good functional outcome (modified Rankin Scale [mRS] 0‒2 at 90 days) was achieved in 24% of the patients in the DWI‒ASPECTS ≤ 5 group. In the DWI‒ASPECTS ≤ 5 group, internal carotid artery occlusion was observed in 86% of the patients who achieved a good functional outcome but in significantly fewer, i. e., 36% of the mRS 3‒6 patients (p=0.023). These results of MT for anterior major vessel occlusion in patients with large early ischemic change demonstrated inferiority compared to the patients with a DWI‒ASPECTS ＞ 6. Successful reperfusion may be related to good functional outcome even in patients with a DWI‒ASPECTS ≤ 5.