title: Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures.
abstract: OBJECTIVE
  Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM).
  
  
  METHODS
  We studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume-computed tomography perfusion or diffusion weighted imaging-magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is <10%.
  
  
  RESULTS
  Fifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume was 28±22 mL, and recanalization thrombolysis in cerebral ischemia 2b-3 was 77%. At 24 hours, mean infarct volume was 64±97 mL, and at 3 months modified Rankin Scale 0 to 2 was 45%. Median lesion growth was smaller in recanalizers (16.7% versus 198.3%; P<0.01). MALCOM was 39 mL. When recanalization was achieved, 64% of patients within MALCOM (<39 mL) achieved favorable outcome, whereas despite recanalization only 12% of patients beyond MALCOM (>39 mL) achieved modified Rankin Scale 0 to 2 (P=0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having admission core lesion below MALCOM (OR: 9.3, 95% CI: 1.9-46.4; P<0.01). Analysis according to imaging modality showed that computed tomography-cerebral blood volume allowed larger MALCOM (42 mL) than magnetic resonance-diffusion weighted imaging (29 mL). In octogenarians, MALCOM (15 mL) was lower in younger patients (40 mL).
  
  
  CONCLUSIONS
  Admission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures.
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. marcriboj@hotmail.com.
authors: Marc
authors: M
authors: Ribo
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Alejandro
authors: A
authors: Tomasello
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Miguel
authors: M
authors: Lemus
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Marta
authors: M
authors: Rubiera
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Carla
authors: C
authors: Vert
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Alan
authors: A
authors: Flores
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Pilar
authors: P
authors: Coscojuela
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Jorge
authors: J
authors: Pagola
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: David
authors: D
authors: Rodriguez-Luna
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Sandra
authors: S
authors: Bonet
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Marian
authors: M
authors: Muchada
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Alex
authors: A
authors: Rovira
authors: From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Carlos A
authors: CA
authors: Molina
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D055420:Perfusion Imaging; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: blood volume; endovascular procedures; magnetic resonance imaging; stroke; thrombectomy