Good outcomes after thrombectomy dependent on time, volume

Amrou Sarraj

Outcomes after endovascular thrombectomy in patients with large core on CT were associated with time and perfusion core volume, according to data presented at the International Stroke Conference.

“Outcomes in stroke patients treated with thrombectomy (mechanical clot removal) is affected by the size of the stroke — the larger the stroke, the worse the outcome,” Amrou Sarraj, MD, associate professor of neurology at McGovern Medical School, The University of Texas Health Science Center in Houston, said in a press release.

Researchers analyzed data from 2,453 patients from the SELECT study and the TREVO registry who had anterior circulation occlusions, were without disability at baseline and were treated within 24 hours. The Alberta Stroke Program Early CT Scores (ASPECTS) were assessed and adjudicated by independent core labs. A large core was defined as ASPECTS of 5 or less. Automated software was used to determine CT perfusion.

The primary outcome of interest was a modified Rankin score between 0 and 2 at 90 days. Secondary outcomes of interest included neurological worsening, symptomatic intracerebral hemorrhage and mortality at 90 days.

Of the patients in the study, 221 had ASPECTS of 5 or less.

Patients with ASPECTS of 5 or less had a good outcome rate of 35%. The rate of good outcomes decreased as CT perfusion increased to less than 50 cc (48%), between 50 cc and 100 cc (20%) and greater than 100 cc (0%; P for trend = .03). The probability of a good outcome decreased by 27% with each 10-cc increase in CT perfusion.

The rate of good outcomes decreased with longer times from onset. CT perfusion core volume of less than 50 cc, between 50 cc and 100 cc and greater than 100 cc were associated with neurological worsening (4%, 22% and 100%, respectively; P for trend < .001) and mortality (4%, 30% and 50%, respectively; P for trend = .006).

The rate of symptomatic intracerebral hemorrhage increased from 4% in patients with volumes up to 100 cc to 75% in those with volumes greater than 100 cc.

“Low rates of good outcomes with thrombectomy beyond 100 cc may still be better than medical management,” Sarraj said during his presentation. “Thus, randomized controlled trials are needed.” – by Darlene Dobkowski

Reference:

Sarraj A, et al. LB8. Presented at: International Stroke Conference; Feb. 6-8, 2019; Honolulu.

Disclosures: The study was partially funded by Stryker Neurovascular. Sarraj reports he received grant support, served as a scientific board adviser, consultant and speaker for Stryker Neurovascular, was the UT-Memorial Hermann Center PI for the TREVO registry and the DEFUSE 3 trial, and was on the registry steering committee for ASSIST.