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Background: Diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) has been used to estimate infarct core volume in acute stroke. However, the same and indiscriminate score deduction for punctate or confluent DWI high-intensity lesion might lead to variation in performance. Aims: To develop and evaluate a differential detailed DWI-ASPECTS method in comparison with the conventional DWI-ASPECTS in core infarct volume measurement and clinical outcome prediction. Methods: We retrospectively recruited patients with acute ischemic stroke (AIS) treated with endovascular treatment between April 2013 and October 2019. In differential detailed DWI-ASPECTS, restricted diffusion lesion that was punctate or less than half of a cortical region (M1–M6) would not lead to subtraction of point. A favorable outcome was modified Rankin Scale score ⩽2 at 90 days after stroke onset. Results: Among 298 AIS patients, mean age was 75 years (interquartile range (IQR) 67–82), and 194 patients (65%) were males. Mean infarct core volume was 11 mL (IQR 3–37). Overall, the score by detailed DWI-ASPECTS was significantly higher than conventional DWI-ASPECTS (8 (7–9) vs. 7 (5–9); P < 0.01). The detailed DWI-ASPECTS resulted in a higher correlation coefficient (r) for core infarct volume estimation than the conventional DWI-ASPECTS (r = 0.832 vs. 0.773; P < 0.01). Upon re-classification of those scored ⩽6 in conventional DWI-ASPECTS (n = 134) by detailed DWI-ASPECTS, the rate of favorable outcome in patients with detailed DWI-ASPECTS >6 was significantly higher than those with ⩽6 (29 (48%) vs. 14 (19%); P < 0.01). Conclusions: Detailed DWI-ASPECTS appeared to provide a more accurate infarct core volume measurement and clinical outcome correlation than conventional DWI-ASPECTS among AIS patients treated with endovascular therapy. [ABSTRACT FROM AUTHOR]

Whether intracranial hemorrhage (ICH) detected using magnetic resonance imaging (MRI) affects the clinical outcomes of patients with large-vessel occlusion (LVO) treated with mechanical thrombectomy (MT) remains unclear. This study investigated the clinical features of ICH after MT detected solely by MRI. This was a retrospective analysis of patients with acute ischemic stroke and occlusion of the internal carotid artery or middle cerebral artery treated with MT between April 2011 and March 2021. Among 632 patients, patients diagnosed with no ICH using CT, with a pre-morbid modified Rankin Scale (mRS) score ≤ 2, and those who underwent MRI including T2* and computed tomography (CT) within 72 h from MT were enrolled. The main outcomes were the association between ICH detected solely by MRI and clinical outcomes at 90 days. Poor clinical outcomes were defined as mRS score > 2 at 90 days after onset. Of the 246 patients, 29 (12%) had ICH on MRI (MRI-ICH(+)), and 217 (88%) were MRI-ICH(−). There was no significant difference between number of patients with MRI-ICH(+) experiencing poor (10 [12%]) and favorable (19 [12%]) outcomes. The mRS score at 90 days between patients with MRI-ICH (+) and MRI-ICH(−) was not significantly different (2 [1–4] vs. 2 [1–4], respectively). Higher age and lower ASPECTS were independent risk factors for poor outcomes, as shown by multivariate regression analysis. MRI-ICH(+) status was not associated with poor outcomes. ICH detected by MRI alone did not influence clinical outcomes in patients with LVO treated with MT. • Whether ICH detected solely by MRI after mechanical thrombectomy affects the clinical outcome in patients with LVO remains unclear. • Among 246 ischemic stroke patients with no ICH detected by CT scan after mechanical thrombectomy, 29 (12 %) patients had ICH detected by MRI. • ICH detected by MRI alone did not influence clinical outcomes in patients with LVO treated with mechanical thrombectomy. [ABSTRACT FROM AUTHOR]

Whether asymptomatic intracranial hemorrhage (ICH) affects the clinical outcomes in patients with acute large vessel occlusion treated with mechanical thrombectomy (MT) remains unclear. This study aimed to address this uncertainty. We retrospectively analyzed patients with acute ischemic stroke and internal carotid or middle cerebral (M1 segment) artery occlusion treated with MT between April 2011 and March 2021 at a single center. All patients had a premorbid modified Rankin scale (mRS) score ≤ 2 and an anterior circulation occlusion and underwent magnetic resonance imaging at admission. Asymptomatic ICH was defined as ICH without symptomatic ICH defined by the SITS-MOST criteria. A favorable outcome was defined as an mRS score ≤ 2 at 90 days after stroke onset. Our study included 349 patients; 62% were men, the median age was 76 [67–83] years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 15 [8–21]. As determined via computed tomography, 103 (30%) patients had ICH (20 symptomatic and 83 asymptomatic). The favorable outcome rate was significantly lower for asymptomatic vs. no ICH (30% vs. 67%, p < 0.01). In a multivariate regression analysis, a high NIHSS score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02–1.10; p < 0.01) and low Alberta Stroke Program Early CT Score (OR, 0.78; 95% CI, 0.65–0.92; p < 0.01) were independent risk factors for ICH. Asymptomatic ICH is associated with poor clinical outcome at 90 days after stroke onset. • Among 349 ischemic stroke patients treated by MT, 103 (30%) patients had ICH (20 symptomatic and 83 asymptomatic). • A high NIHSS score and low ASPECTS were independent risk factors for ICH. • Asymptomatic ICH was associated with poor clinical outcome at 90 days after stroke onset. [ABSTRACT FROM AUTHOR]

The long-term outcome in acute stroke patients with large vessel occlusion (LVO) treated with endovascular therapy (EVT) are unclear. We investigated functional outcomes one year after EVT in acute stroke patients with LVO. We retrospectively enrolled 149 stroke patients with LVO who underwent EVT from our prospective stroke registry. We assessed modified Rankin Scale (mRS) scores at one year from onset. The degree of recanalization was evaluated using modified thrombolysis in cerebral infarction (mTICI) grades. Good recanalization and a favorable outcome were defined as an mTICI grade ≥ 2b and mRS score ≤ 2, respectively. Favorable outcomes were observed in 76 (51.0%) patients. The favorable outcome group was younger (median age: 72 [interquartile range, 63–79] years vs. 79 [70–84] years, P <.001) and had more male patients (79% vs. 60%, P =.013), lower National Institutes of Health Stroke Scale scores at admission (median 14 [7–18]) vs. 19 [15–25], P <.001), higher DWI-ASPECTS upon admission (median [6–9] vs. 6 [4–8], P =.022), more patients with mTICI ≥ 2b (93% vs. 64%, P <.001) and fewer post-therapy intracranial cerebral hemorrhages (13% vs. 29%, P =.019) than the poor outcome group. In our multivariate analysis, mTICI ≥ 2b were independently associated with favorable outcomes at one year from onset (odds ratio, 10.282; 95% confidence interval, 1.587–66.604; P =.015). Good recanalization was associated with favorable functional outcomes one year after EVT in acute stroke patients with LVO. • The number of patients with mRS score ≤ 2 at 90 days did not decrease at one year. • Favorable outcomes one-year from onset were associated with mTICI grade ≥ 2b. • DWI-ASPECTS on arrival was high in the favorable outcome group. • Good recanalization should be associated with good functional outcomes. [ABSTRACT FROM AUTHOR]

We investigated the impact of complete recanalization beyond partial recanalization in distal (M2) middle cerebral artery (MCA) occlusion. Data regarding M2 occlusion patients treated with endovascular thrombectomy (EVT) and/or intravenous thrombolysis (tPA) were reviewed from our prospective EVT registry and multicenter tPA (YAMATO study) data bank. Complete recanalization was modified thrombolysis with cerebral infarction score (TICI) of 3 at the end of EVT or similar appearances of both MCAs on magnetic resonance angiography (MRA) within 1.5 h after tPA. Partial recanalization was defined as TICI ≥2b or > 50% recanalization on MRA. At 3 months, favorable outcome was defined as a modified Rankin Scale score ≤ 2. Data on 121 patients were analyzed. EVT-alone was in 38 patients; combined EVT and tPA in 28; and tPA-alone in 55. Complete recanalization was achieved in 27 (22%), partial recanalization in 48 (40%), and no-to-limited recanalization in 46 (38%). At 3 months, 51% of patients had favorable outcomes, and this rate was significantly higher in the complete recanalization group than in the partial and no-to-limited recanalization groups (75% vs. 41% vs. 49%, p =.043). Multivariate regression analysis showed that complete recanalization was an independent parameter related to favorable outcomes (odds ratio 4.78, 95% CI: 1.16–19.73, p =.030). However, combined complete and partial recanalization was not associated with favorable outcomes (odds ratio 1.49, 95% CI 0.53–4.22, p =.449). Complete recanalization, but not partial recanalization, at the end of EVT and tPA therapy is associated with favorable outcomes in patients with M2 occlusion. • Impact of rapid complete recanalization after EVT in M2 occlusion was evaluated. • EVT-alone was in 38; combined EVT and tPA in 28; and tPA-alone in 55 patients. • Favorable outcome was high as 75% in complete recanalization than others (41%; significant, and 49%; no-to-mild). • Complete recanalization was an independent parameter of favorable outcome. • Rapid complete but not significant recanalization is associated with favorable outcomes. [ABSTRACT FROM AUTHOR]