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Endovascular clot retrieval in acute stroke with large ischaemic core is not always associated with poor outcomes
Author(s) -
Sim Kenneth,
Yan Bernard,
Dowling Richard,
Bush Steven,
Mitchell Peter
Publication year - 2019
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14116
Subject(s) - medicine , ischaemic stroke , interquartile range , contraindication , stroke (engine) , core (optical fiber) , modified rankin scale , thrombolysis , perfusion scanning , surgery , perfusion , cardiology , ischemic stroke , ischemia , myocardial infarction , mechanical engineering , materials science , alternative medicine , pathology , engineering , composite material
Background The benefits of endovascular clot retrieval (ECR) for anterior circulation stroke with large ischaemic cores remain uncertain. In spite of recent pooled analysis of randomised controlled studies, conclusions regarding the fate of large ischaemic cores cannot be reached given the small number of included patients. Aim To evaluate outcomes of ECR in acute stroke with large ischaemic core. Methods This was a single centre retrospective study of patients treated with ECR in the period 2012–2017. The inclusion criteria were anterior circulation stroke with symptom onset less than 6 h, baseline computed tomography perfusion and a 90‐day clinical follow up defined by the modified Rankin score. Results Two hundred and sixty‐one patients were included. Median age of 72 (interquartile range: 61–78) and 59% were male. The mean ischaemic core volume was 27.6 mL (SD: 34.9 mL). There were 235 patients with an ischaemic core volume of <70 mL and 26 patients with an ischaemic core volume of ≥70 mL. There was no statistically significant difference; however, in a 90‐day functional independence with 66% (154/235) in the <70 mL core group and 54% (14/26) in the ≥70 mL core group reaching a 90‐day modified Rankin score ≤2. Conclusions We found that patients selected for ECR with ischaemic core size ≥70 mL had clinical outcomes not significantly different compared with those with smaller ischaemic cores. We recommend that large ischaemic core size alone does not necessarily constitute an absolute contraindication for ECR. Randomised controlled studies are needed to define better the benefits for this group of patients.