Predictors of independent outcome of thrombectomy in stroke patients with large baseline infarcts in clinical practice: a multicenter analysis

J Neurointerv Surg. 2020 Nov;12(11):1064-1068. doi: 10.1136/neurintsurg-2019-015641. Epub 2020 Feb 27.


Objective: To analyze outcome and its predictors after endovascular treatment (ET) in stroke patients suffering from large vessel occlusion with large pre-treatment infarct cores defined by an Alberta Stroke Program Early CT Score (ASPECTS) <6.

Methods: We analyzed data from an industry-independent, multicenter, prospective registry (German Stroke Registry - Endovascular Treatment) which enrolled consecutive patients treated by ET (June 2015-April 2018) with different devices. Multivariate logistic regression analyses identified predictors of independent outcome (IO) defined as a modified Rankin Scale (mRS) 0-2, and mortality at 90 days in patients with ASPECTS <6.

Results: Of 1700 patients included in the analysis, 152 (8.9%) had a baseline ASPECTS <6. Of these, 33 patients (21.6%) achieved IO, and 68 (44.7%) were dead at 90 days. A lower age, lower baseline National Institutes of Health Stroke Scale (NIHSS) score, and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) were predictors of IO. Successful recanalization had the strongest association with IO (OR 7.0, 95% CI 1.8 to 26.8). Pre-treatment parameters predicting IO were age <70 years (sensitivity 0.79, specificity 0.69) and NIHSS <12 (0.57 and 0.94). A higher age, a pre-stroke mRS score >1, and failed recanalization were predictors of death.

Conclusions: A substantial proportion of stroke patients with an ASPECTS <6 can achieve independence after thrombectomy, in particular, if they are younger, have only moderate baseline stroke symptoms, and no relevant pre-stroke disability. These results may encourage considering thrombectomy in low ASPECTS patients in clinical practice until randomized trials are available.

Keywords: angiography; stroke; thrombectomy.

Publication types

  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / therapy
  • Cerebral Infarction / complications
  • Cerebral Infarction / mortality
  • Cerebral Infarction / therapy*
  • Disability Evaluation
  • Female
  • Germany
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Registries
  • Stroke / complications
  • Stroke / mortality
  • Stroke / therapy*
  • Thrombectomy / methods*
  • Treatment Outcome