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DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke

Abstract : BACKGROUND AND PURPOSE The reasons for poor clinical outcome after thrombectomy for acute stroke, concerning around half of all patients, are misunderstood. We developed a hierarchic algorithm based on DWI to better identify patients at high risk of disability. MATERIALS AND METHODS Our single-center, retrospective study included consecutive patients with acute ischemic stroke who underwent thrombectomy for large anterior artery occlusion and underwent pretreatment DWI. The primary outcome was the mRS at 3 months after stroke onset. Multivariable regression was used to identify independent clinical and imaging predictors of poor prognosis (mRS > 2) at 3 months, and a hierarchic algorithm predictive of disability was developed. RESULTS A total of 149 patients were analyzed. In decreasing importance, DWI lesion volume of >80 mL, baseline NIHSS score of >14, age older than 75 years, and time from stroke onset to groin puncture of >4 hours were independent predictors of poor prognosis. The predictive hierarchic algorithm developed from the multivariate analysis predicted the risk of disability at 3 months for up to 100% of patients with a high predictive value. The area under the receiver operating characteristic curve was 0.87. CONCLUSIONS The DWI-based hierarchic algorithm we developed is highly predictive of disability at 3 months after thrombectomy and is easy to use in routine practice. © 2020 by American Journal of Neuroradiology.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-02499727
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Submitted on : Thursday, March 5, 2020 - 2:47:35 PM
Last modification on : Thursday, June 18, 2020 - 9:29:21 AM

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H. Raoult, M.V. Lassalle, B. Parat, C. Rousseau, F. Eugène, et al.. DWI-Based Algorithm to Predict Disability in Patients Treated with Thrombectomy for Acute Stroke. American Journal of Neuroradiology, American Society of Neuroradiology, 2020, 41 (2), pp.274-279. ⟨10.3174/ajnr.A6379⟩. ⟨hal-02499727⟩

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