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BACKGROUND AND OBJECTIVES: The effect of mechanical thrombectomy (MT) on functional outcome in ischemic stroke patients with low ASPECTS is still uncertain. ASPECTS rating is based on the presence of ischemic hypoattenuation relative to normal, however the degree of hypoattenuation, which directly reflects net uptake of water, is currently not considered as imaging biomarker in stroke triage. We hypothesized that the effect of thrombectomy on functional outcome in low ASPECTS patients depends on early lesion water uptake.METHODS: For this multicenter observational study, anterior circulation stroke patients with ASPECTS=5 were consecutively analyzed. Net water uptake (NWU) was assessed as quantitative imaging biomarker in admission-CT. Primary endpoint was the rate of favorable functional outcome defined as modified Rankin Scale (mRS) score 0-3 at day 90. The effect of recanalization on functional outcome was analyzed according to the degree of NWU within the early infarct lesion.RESULTS: 254 patients were included, of which 148 (58%) underwent MT. The median ASPECTS was 4 (IQR: 3-5), and the median NWU was 11.4% (IQR: 8.9-15.1%). The rate of favorable outcome was 27.6% in patients with low NWU (<11.4%) versus 6.3% in patients with high NWU (=11.4%; p<0.0001). In multivariable logistic regression analysis, NWU was an independent predictor of outcome, while vessel recanalization (mTICI=2b) was only significantly associated with better outcomes if NWU was lower than 12.6%. In inverse-probability weighting analysis, recanalization was associated with 20.7% (p=0.01) increase in favorable outcome in patients with low NWU compared to 9.1% (p=0.06) in patients with high NWU.DISCUSSION: Early NWU was independently associated with clinical outcome, and might serve as an indicator of futile MT in low ASPECTS patients. NWU could be tested as tool to select low ASPECTS patients for MT.
View details for DOI 10.1212/WNL.0000000000201601
View details for PubMedID 36414425