2020 Volume 42 Issue 3 Pages 141-147
Background and Purpose: The efficacy of thrombectomy in patients showing extensive signal hyperintensity on diffusion-weighted magnetic resonance imaging has not been established. We evaluated outcomes of thrombectomy in patients with a low diffusion-weighted imaging-Alberta stroke program early computed tomography score (DWI-ASPECTS). Methods: Among 167 patients who underwent thrombectomy at our hospital between January 1, 2015 and August 31, 2018, we enrolled 21 patients with a preoperative DWI-ASPECTS ≤ 5. Results: Preoperative DWI-ASPECTS was 2 in two, 3 in seven, 4 in five, and 5 in seven patients. Based on magnetic resonance angiography, vascular occlusion sites were the internal carotid artery in 14 patients and the middle cerebral artery in seven. Modified Rankin Scale (mRS) at discharge was 0 in two patients, 1–4 in one patient each, 5 in 11 patients, and 6 in four patients. When background factors were compared between patients with favorable outcomes (mRS 0–2) and those with unfavorable outcomes (mRS 3–6) at discharge, significantly fewer patients in the favorable outcome group showed signal hyperintensity in the M5 segment (favorable, 25%; unfavorable, 94.1%; P = 0.012) and occluded internal carotid artery (favorable, 0%; unfavorable, 82%; P = 0.006). Conclusion: After thrombectomy for acute cerebral infarction, outcomes at discharge were frequently unfavorable in patients with preoperative DWI-ASPECTS ≤ 5. To perform thrombectomy in patients with low DWI-ASPECTS, predictors of postoperative prognosis must be clarified.
