title: Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤6.
abstract: In acute ischemic stroke patients, diffusion-weighted imaging (DWI)-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcome. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or under-represented in the recent randomized mechanical thrombectomy trials. Our aim was to assess the impact of reperfusion in pretreatment DWI-ASPECTS ≤6 patients treated with mechanical thrombectomy.
  
  
  
  We analyzed data collected between January 2012 and August 2015 in a bicentric prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with a documented internal carotid artery or middle cerebral artery occlusion with pretreatment DWI-ASPECTS ≤6 was eligible for this study. The primary end point was a favorable outcome defined by a modified Rankin Scale score ≤2 at 90 days.
  
  
  
  Two hundred and eighteen patients with a DWI-ASPECTS ≤6 were included. Among them, 145 (66%) patients had successful reperfusion at the end of mechanical thrombectomy. Reperfused patients had an increased rate of favorable outcome (38.7% versus 17.4%;P=0.002) and a decreased rate of mortality at 3 months (22.5% versus 39.1%;P=0.013) compared with nonreperfused patients. The symptomatic intracranial hemorrhage rate was not different between the 2 groups (13.0% versus 14.1%;P=0.83). However, in patients with DWI-ASPECTS <5, favorable outcome was low (13.0% versus 9.5%;P=0.68) with a high mortality rate (45.7% versus 57.1%;P=0.38) with or without successful reperfusion.
  
  
  
  Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5.
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.). jpdesilles@for.paris.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Desilles
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Arthuro
authors.initials: A
authors.lastname: Consoli
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Hocine
authors.initials: H
authors.lastname: Redjem
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Coskun
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ciccio
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Stanislas
authors.initials: S
authors.lastname: Smajda
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Cristian
authors.initials: C
authors.lastname: Preda
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Clara
authors.initials: C
authors.lastname: Ruiz Guerrero
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Decroix
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Georges
authors.initials: G
authors.lastname: Rodesch
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Raphaël
authors.initials: R
authors.lastname: Blanc
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Michel
authors.initials: M
authors.lastname: Piotin
authors.affiliation: From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D015424:Reperfusion / Q000379:methods*; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: ischemic stroke; large ischemic lesion; outcome; reperfusion; thrombectomy