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Koch PJ, Rudolf LF, Schramm P, Frontzkowski L, Marburg M, Matthis C, Schacht H, Fiehler J, Thomalla G, Hummel FC, Neumann A, Münte TF, Royl G, Machner B, Schulz R. Preserved Corticospinal Tract Revealed by Acute Perfusion Imaging Relates to Better Outcome After Thrombectomy in Stroke. Stroke 2023; 54:3081-3089. [PMID: 38011237 DOI: 10.1161/strokeaha.123.044221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The indication for mechanical thrombectomy (MT) in stroke patients with large vessel occlusion has been constantly expanded over the past years. Despite remarkable treatment effects at the group level in clinical trials, many patients remain severely disabled even after successful recanalization. A better understanding of this outcome variability will help to improve clinical decision-making on MT in the acute stage. Here, we test whether current outcome models can be refined by integrating information on the preservation of the corticospinal tract as a functionally crucial white matter tract derived from acute perfusion imaging. METHODS We retrospectively analyzed 162 patients with stroke and large vessel occlusion of the anterior circulation who were admitted to the University Medical Center Lübeck between 2014 and 2020 and underwent MT. The ischemic core was defined as fully automatized based on the acute computed tomography perfusion with cerebral blood volume data using outlier detection and clustering algorithms. Normative whole-brain structural connectivity data were used to infer whether the corticospinal tract was affected by the ischemic core or preserved. Ordinal logistic regression models were used to correlate this information with the modified Rankin Scale after 90 days. RESULTS The preservation of the corticospinal tract was associated with a reduced risk of a worse functional outcome in large vessel occlusion-stroke patients undergoing MT, with an odds ratio of 0.28 (95% CI, 0.15-0.53). This association was still significant after adjusting for multiple confounding covariables, such as age, lesion load, initial symptom severity, sex, stroke side, and recanalization status. CONCLUSIONS A preinterventional computed tomography perfusion-based surrogate of corticospinal tract preservation or disconnectivity is strongly associated with functional outcomes after MT. If validated in independent samples this concept could serve as a novel tool to improve current outcome models to better understand intersubject variability after MT in large vessel occlusion stroke.
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Affiliation(s)
- Philipp J Koch
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
| | - Linda F Rudolf
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Peter Schramm
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Lukas Frontzkowski
- Department of Neurology (L.F., G.T., R.S.) University Medical Center Hamburg Eppendorf, Germany
| | - Maria Marburg
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Christine Matthis
- Department of Social Medicine and Epidemiology (C.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Hannes Schacht
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Jens Fiehler
- Department of Neuroradiology (J.F.) University Medical Center Hamburg Eppendorf, Germany
| | - Götz Thomalla
- Department of Neurology (L.F., G.T., R.S.) University Medical Center Hamburg Eppendorf, Germany
| | - Friedhelm C Hummel
- Neuro-X Institute and Brain Mind Institute, Swiss Federal Institute of Technology, Geneva, Switzerland (F.C.H.)
- Neuro-X Institute and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland (F.C.H.)
- Clinical Neuroscience, University of Geneva Medical School, Switzerland (F.C.H.)
| | - Alexander Neumann
- Department of Neuroradiology (L.F.R., P.S., H.S., A.N.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Thomas F Münte
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
| | - Georg Royl
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
| | - Björn Machner
- Department of Neurology (P.J.K., M.M., G.R., B.M.), University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Germany (P.J.K., T.F.M., G.R., B.M.)
- Department of Neurology, Schoen Clinic Neustadt, Holstein, Germany (B.M.)
| | - Robert Schulz
- Department of Neurology (L.F., G.T., R.S.) University Medical Center Hamburg Eppendorf, Germany
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