Introduction: Optimal imaging before endovascular thrombectomy for large vessel occlusion remains unclear. We compared pre-treatment DWI ASPECTS and CT perfusion (CTP) to identify which imaging better predicted clinical outcome after endovascular thrombectomy.
Methods: Prospectively collected date for consecutive patients treated with endovascular thorombectomy for acute intracranial internal carotid artery or M1 occlusion and underwent both MRI and CTP before endovascular thrombectomy was analyzed retrospectively. CTP maps were assessed for relative values (rCBF, rCBV and rMTT) obtained for the MCA cortical regions. Pre-treatment DWI ASPECTS and each relative CTP values were compared between good clinical outcome group and poor clinical outcome group. Receiver operating characteristic (ROC) curve analysis was performed to determine the most accurate imaging parameter for the prediction of good clinical outcome.
Results: Sixty-nine patients were eligible for this study. Average age was 74.4 years, median NIHSS on admission was 17. The median time from MRI to CTP was 21 minutes. TICI 2B or more recanalization was achieved in 44 patients. Twenty-four patients achieved good clinical outcomes. DWI ASPECTS (9 vs. 6, p=0.003) and rCBV (0.99 vs. 0.83, p=0.017) were significantly higher in the good clinical outcome group. The area under the ROC curve for good clinical outcome was 0.714 for DWI ASPECTS and 0.676 for rCBV. In the patients with TICI 2B or more recanalization, DWI ASPECTS were significantly higher (9 vs. 6.5, p=0.027) and rCBV tended to be higher (1.01 vs. 0.83, p=0.071) in the good clinical outcome group. The area under the ROC curve was 0.693 for DWI ASPECTS and 0.659 for rCBV in the patients with TICI 2B or more recanalization.
Conclusions: DWI ASPECTS and rCBV could predict clinical outcome after endovascular thrombectomy. DWI ASPECTS better predicted clinical outcome than CTP.