Identifying large ischemic core volume ranges in acute stroke that can benefit from mechanical thrombectomy

Takeshi Yoshimoto, Manabu Inoue, Kanta Tanaka, Kodai Kanemaru, Junpei Koge, Masayuki Shiozawa, Naruhiko Kamogawa, Shunsuke Kimura, Tetsuya Chiba, Tetsu Satow, Jun C. Takahashi, Kazunori Toyoda, Masatoshi Koga, Masafumi Ihara

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)

Abstract

Background We aimed to identify the large ischemic core (LIC) volume ranges in acute ischemic stroke patients that can benefit from mechanical thrombectomy (MT). Methods Consecutive patients within 24 hours of onset of anterior circulation ischemic stroke with large vessel occlusion and ischemic core volumes of 70-300 mL were included from our single-center prospective database from March 2014 to December 2019. Subjects were divided into three groups by baseline ischemic core volume (A: 70-100 mL; B: 101-130 mL; C: >130 mL). We compared modified Rankin Scale (mRS) score 0-2 at 3 months and parenchymal hematoma between patients receiving MT and standard medical treatment (SMT), and determined clinically treatable core volume ranges for MT. Results Of 157 patients (86 women; median age, 81 years; median ischemic core volume, 123 mL), 49 patients underwent MT. In Group A (n=52), MT patients (n=31) showed a higher proportion of mRS 0-2 at 3 months (52% vs 5%, P<0.05) versus SMT, respectively. Group B (n=36) MT patients (n=14) also had a higher proportion of mRS 0-2 at 3 months (29% vs 9%, P=0.13) versus SMT, respectively. In Group C (n=69), only four patients received MT. The 95% confidence intervals for the probability of mRS 0-2 at 3 months in patients with MT (n=49) versus SMT (n=108) intersected at 120-130 mL. Conclusions Ischemic core volumes between 70 and 100 mL may benefit from MT. The treatable upper core limit is approximately 120 mL in selected patients with LIC of 70-300 mL.

Original languageEnglish
Pages (from-to)1081-1087
Number of pages7
JournalJournal of NeuroInterventional Surgery
Volume13
Issue number12
DOIs
Publication statusPublished - 2021
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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