Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke.
Clin Neuroradiol. 2022-04-12; 32(4): 939-950
DOI: 10.1007/s00062-022-01156-z
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Panni P(1), Lapergue B(2), Maïer B(3), Finitsis S(4), Clarençon F(5), Richard
S(6)(7), Marnat G(8), Bourcier R(3), Sibon I(9), Dargazanli C(10), Blanc R(11),
Consoli A(12), Eugène F(13), Vannier S(14), Spelle L(15), Denier C(16),
Boulanger M(17), Gauberti M(18), Saleme S(19), Macian F(20), Rosso C(21),
Naggara O(22), Turc G(23), Ozkul-Wermester O(24), Papagiannaki C(25), Albucher
JF(26), Darcourt J(27), Le Bras A(28), Evain S(29), Wolff V(30), Pop R(31),
Timsit S(32), Gentric JC(33), Bourdain F(34), Veunac L(35), Arquizan C(36), Gory
B(37)(38); ETIS (Endovascular Treatment in Ischemic Stroke) investigators.
Collaborators: Piotin M, Blanc R, Redjem H, Escalard S, Dessilles JP, Delvoye F,
Smajda S, Maier B, Solène H, Mazighi M, Obadia M, Sabben C, Seners P, Raynouard
I, Corabianu O, de Broucker T, Manchon E, Taylor G, Ben Maacha M, Thion LA,
Lecler A, Savatovsky J, Wang A, Evrard S, Tchikviladze M, Ajili N, Lapergue B,
Weisenburger-Lile D, Gorza L, Buard G, Coskun O, Consoli A, Di Maria F, Rodesch
G, Zimatore S, Leguen M, Gratieux J, Pico F, Rakotoharinandrasana H, Tassan P,
Poll R, Marinier S, Marnat G, Gariel F, Barreau X, Berge J, Menegon P, Sibon I,
Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F,
Tourdias T, Liegey JS, Briau P, Pangon N, Bourcier R, Detraz L, Daumas-Duport B,
Alexandre PL, Roy M, Lenoble C, Desal H, Guillon B, de Gaalon S, Preterre C,
Gory B, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F,
Schmitt E, Planel S, Richard S, Humbertjean L, Mione G, Lacour JC, Audibert G,
Voicu M, Alb L, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Bourst P,
Guy S, Bechiri F, Macian-Montoro F, Saleme S, Mounayer C, Rouchaud A, Gimenez L,
Cosnard A, Costalat V, Arquizan C, Dargazanli C, Gascou G, Lefèvre PH, Derraz I,
Riquelme C, Gaillard N, Mourand I, Corti L, Cagnazzo F, Ter Schiphorst A, Eugene
F, Vannier S, Ferre JC, Raoult H, Ronziere T, Lassale M, Paya C, Gauvrit JY,
Tracol C, Langnier-Lemercier S, Maurice A, Cochennec S, Pinault M, Clarençon F,
Shotar E, Sourour N, Lenck S, Premat K, Samson Y, Léger A, Crozier S, Baronnet
F, Alamowitch S, Bottin L, Yger M, Degos V, Spelle L, Denier C, Chassin O,
Chalumeau V, Caroff J, Chassin O, Venditti L, Sarov M, Legris N, Naggara O, Ben
Hassen W, Boulouis G, Rodriguez-Régent C, Trystram D, Kerleroux B, Turc G,
Domigo V, Lamy C, Birchenall J, Isabel C, Lun F, Viguier A, Cognard C, Januel
AC, Olivot JM, Fontaine L, Raposo N, Bonneville F, Albucher JF, Calviere L,
Darcourt J, Bellanger G, Tall P, Touze E, Barbier C, Schneckenburger R,
Boulanger M, Cogez J, Guettier S, Gauberti M, Timsit S, Gentric JC, Ognard J,
Merrien FM, Wermester OO, Massardier E, Papagiannaki C, Triquenot A, Lefebvre M,
Bourdain F, Bernady P, Lagoarde-Segot L, Cailliez H, Veunac L, Higue D, Wolff V,
Quenardelle V, Lauer V, Gheoca R, Pierre-Paul I, Pop R, Beaujeux R, Mihoc D,
Manisor M, Pottecher J, Meyer A, Chamaraux-Tran TN, Le Bras A, Evain S, Le Guen
A.
Author information:
(1)Department of Neuroradiology, Division of Interventional Neuroradiology,
Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy.
.
(2)Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines
University, Suresnes, France.
(3)Department of Interventional Neuroradiology, Rothschild Foundation, Paris,
France.
(4)AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
(5)Department of Neuroradiology, CHU Pitié-Salpétrière, Paris, France.
(6)CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine,
54000, Nancy, France.
(7)CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France.
(8)Department of Diagnostic and Interventional Neuroradiology, University
Hospital of Bordeaux, Bordeaux, France.
(9)Neurology, University Hospital of Bordeaux, Bordeaux, France.
(10)Department of Interventional Neuroradiology, CHRU Gui de Chauliac,
Montpellier, France.
(11)Department of Neuroradiology, University Hospital of Nantes, Nantes, France.
(12)Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles
Saint-Quentin en Yvelines University, Suresnes, France.
(13)Department of Neuroradiology, University Hospital of Rennes, Rennes, France.
(14)Neurology, University Hospital of Rennes, Rennes, France.
(15)Neuroradiology, CHU Kremlin Bicêtre, Paris, France.
(16)Department of Neurology, CHU Kremlin Bicêtre, Paris, France.
(17)Department of Neurology, CHU Caen, Caen, France.
(18)Neuroradiology, CHU Caen, Caen, France.
(19)Neuroradiology, CHU Limoges, Limoges, France.
(20)Department of Neurology, CHU Limoges, Limoges, France.
(21)Department of Neurology, CHU Pitié-Salpétrière, Paris, France.
(22)Neuroradiology, Hôpital Saint-Anne, Paris, France.
(23)Department of Neurology, Hôpital Saint-Anne, Paris, France.
(24)Department of Neurology, CHU Rouen, Rouen, France.
(25)Neuroradiology, CHU Rouen, Rouen, France.
(26)Department of Neurology, CHU Toulouse, Toulouse, France.
(27)Neuroradiology, CHU Toulouse, Toulouse, France.
(28)Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France.
(29)Neurology, CHBA Bretagne Atlantique, Vannes, France.
(30)Department of Neurology, CHU Strasbourg, Strasbourg, France.
(31)Neuroradiology, CHU Strasbourg, Strasbourg, France.
(32)Department of Neurology, CHU Brest, Brest, France.
(33)Neuroradiology, CHU Brest, Brest, France.
(34)Department of Neurology, CH Côte Basque, Bayonne, France.
(35)Neuroradiology, CH Côte Basque, Bayonne, France.
(36)Neurology, CHRU Gui de Chauliac, Montpellier, France.
(37)CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology,
Université de Lorraine, 54000, Nancy, France.
(38)IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France.
PURPOSE: To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS
(diffusion weighted imaging Alberta Stroke Program CT Score) template should
serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS)
patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated
with thrombectomy, and to determine its predictors in current practice.
METHODS: We analyzed data of all consecutive patients included in the
prospective multicenter national Endovascular Treatment in Ischemic Stroke
Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2,
who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy
and had an available 24 h post-interventional MRI follow-up. Multivariable
analyses were performed to evaluate the clinical impact of DWIr on early
neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score
distribution (shift analysis) and to define independent predictors of DWIr.
RESULTS: Early neurological improvement was detected in 82/211 (41.7%) of
patients while 3‑month functional independence was achieved by 75 (35.5%)
patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of
both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR
for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization
(mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3,
95% CI 1.3-7.9; p 0.009).
CONCLUSION: The DWI reversal occurs in a non-negligible proportion of
DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences
clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr
predictor.
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
DOI: 10.1007/s00062-022-01156-z
PMID: 35412044 [Indexed for MEDLINE]