title: Clinical and radiological outcome after mechanical thrombectomy in acute ischemic stroke: What matters?
abstract: OBJECTIVE
  Recent studies have shown the efficacy of mechanical thrombectomy in acute ischemic stroke. We sought to identify prognostic parameters for clinical and radiological outcome after mechanical thrombectomy.
  
  
  METHODS
  In 34 patients (age 72 ± 13 years, 64.7% women) with acute occlusion of the distal ICA and/or M1 segment who were treated with mechanical thrombectomy, the Spearman correlation was performed to assess potential prognostic outcome parameters (age, NIHSS, ASPECT, thrombus length (TL), clot burden score (CBS), relative filling time delay (rFTD), time to recanalization (TTR) and TICI score). The modified Rankin scale (mRS) and the Alberta Stroke Program Early CT (ASPECT) score were used for clinical and radiological outcome, respectively. Receiver operating characteristic (ROC) analysis was performed to assess parameters predicting favorable clinical (ΔmRS ≤ 2) and radiological outcome (ΔASPECT ≤ 2).
  
  
  RESULTS
  Variables associated with favorable clinical outcome included NIHSS, TL, TTR and TICI score (p ≤ 0.01) with NIHSS ≤ 15 (p = 0.001, area under the curve (AUC) 0.87), TL ≤ 2 cm (p = 0.017, AUC 0.75), TTR ≤ 231 min (p = 0.001 AUC 0.88) and TICI ≥ 2b (p = 0.050, AUC 0.70). Shorter TTR and higher TICI scores were associated with favorable radiological outcome (p < 0.001) with TTR ≤ 224 min (p = 0.023, AUC 0.77) and TICI ≥ 2b (p = 0.000, AUC 0.86).
  
  
  CONCLUSIONS
  Fast and complete recanalization is essential to achieve a favorable radiological and functional outcome after mechanical thrombectomy in acute ischemic stroke. Age, CBS and collateral supply play a subordinate role.
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Germany iris.kaschka@uk-erlangen.de.
authors.forename: Iris N
authors.initials: IN
authors.lastname: Kaschka
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Germany.
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Kloska
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Struffert
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Engelhorn
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Gölitz
authors.affiliation: Department of Neurology, University Hospital Erlangen, Germany.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kurka
authors.affiliation: Department of Neurology, University Hospital Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.affiliation: Department of Neurology, University Hospital Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.affiliation: Department of Neuroradiology, University Hospital Erlangen, Germany.
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
keywords: 4D computed tomography; Stroke; collateral circulation; mechanical thrombectomy; outcome; perfusion imaging