AUTHOR=Yang Hongchao , Lin Dinglai , Lin Xiaohui , Wu Yanmin , Yi Tingyu , Chen Wenhuo 

TITLE=Outcomes and CT Perfusion Thresholds of Mechanical Thrombectomy for Patients With Large Ischemic Core Lesions

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.856403

DOI=10.3389/fneur.2022.856403

ISSN=1664-2295

ABSTRACT=Objective To explore the clinical prognosis and factors after mechanical 
thrombectomy(MT) in patients with large cerebral infarction assessed by computed 
tomographic perfusion(CTP), and the optimal threshold of cerebral blood flow(CBF) 
for estimating ischemic core.
Methods We analyzed data from the anterior circulation database of our 
hospital(August 2018-June 2021). Multivariate logistic regression analyses identified 
the predictors of clinical outcomes for patients with large baseline infarcts(>50ml) 
assessed by the MIstar software. The ROC analysis was used to explore the cut-off 
value of factors. 
Results 137 patients with large baseline infarcts were included in the present study. 
23(16.8%) patients achieved functionally independent outcomes, and 50(36.5%) were 
dead at 90 days. A total of 20(14.7%) patients had symptomatic intracranial 
hemorrhage (sICH). The multivariable analysis showed higher age and larger core 
volume were independent factors of poor outcomes. The cutoff value of core volume 
was 90ml, and the age was 76 years. Hypertension and rt-PA treatment were 
independent factors of sICH. Higher age and larger ischemic volume were 
independent risk factors of mortality.
Conclusions MT can be applied in patients with large ischemic core volumes. 
Patients older than 76 years and the baseline infarcts larger than 90 ml are more likely 
to suffer from poor outcomes. These findings may be helpful to select patients with 
large baseline infarcts to be treated by MT. The threshold of CBF<30% is the 
independent factor, and this is worth evaluating in future studies to find the optimal 
threshold of CBF.