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Objective: Stroke patients with large core infarctions benefit from endovascular intervention, though only approximately 20% are functionally independent at 90 days. We studied prognostic factors for patients presenting with a large computed tomography perfusion (CTP) core. Methods: Retrospective analysis from a health system stroke registry, including consecutive thrombectomy patients treated within 24 hours from August 2020-December 2022 with an anterior circulation large vessel occlusion and CTP core infarct ≥50 milliliters. Logistic regression was used to determine independent predictors of 90-day modified Rankin Scale (mRS) score 4–6. The prognostic ability of previously reported scales was also assessed. Results: In 118 included patients, with mean age 64.3 ± 14.1 years, poor functional outcomes were present in 66 subjects (55.9%). The multivariable regression analysis demonstrated that higher presenting National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.02–1.23, p = 0.014), elevated glucose (OR 1.02, 95% CI 1.01–1.03, p = 0.002), absence of treatment with intravenous thrombolysis (OR 4.01, 95% CI 1.35–11.95, p = 0.013), and poor revascularization (OR 4.76, 95% CI 1.24–18.37, p = 0.023) were independently associated with primary outcome. The Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS) predicted 90-day mRS 4–6 (per 25-point increase, OR 1.22, 95% CI 1.10–1.34, p<0.001) and mRS 5–6 (per 25-point increase, OR 1.21, 95% CI 1.10–1.33, p<0.001). Nineteen of 20 (95%) patients with CLEOS ≥ 675 had 90-day mRS scores of 4–6, while 10 of 12 (83.3%) with CLEOS ≥ 725 had 90-day mRS scores of 5–6. Conclusion: We report prognostic factors that can risk stratify thrombectomy patients with large CTP core infarctions. [ABSTRACT FROM AUTHOR]

Background and Purpose: The role of CT perfusion (CTP)in the evaluation of acute basilar artery occlusion (aBAO) patients undergoing endovascular thrombectomy (EVT) is unclear. We investigated the association of individual CTP parameters with functional outcomes in aBAO patients undergoing EVT. Methods: A health system's prospectively collected code stroke registry was used in this retrospective analysis of aBAO patients treated with EVT presenting between January 2017 and February 2021 with pre‐EVT CTP. The primary outcome measure was modified Rankin Scale (mRS) score 0‐2 at 90 days. Factors with a univariate association (p <.05) with mRS 0‐2 were combined in a multivariable regression model to determine independent predictors of 90‐day favorable functional outcome. Results: Forty‐six subjects, with median age 67 years and median National Institutes of Health Stroke Scale 16, were included, of whom 17 (37%) achieved mRS 0‐2 at 90 days. In the multivariable logistic regression model, CTP cerebral blood volume (CBV) index (per 0.1‐point increase, odds ratio = 1.843; 95% confidence interval: 1.039, 3.268; p‐value.0365) was independently associated with a favorable 90‐day outcome. Conclusions: CBV index was independently associated with a favorable 90‐day outcome in aBAO patients treated with EVT, a novel finding in this patient population. CBV index may assist in treatment and prognosis discussions and inform future studies investigating the role of CTP in aBAO. [ABSTRACT FROM AUTHOR]

Background: The DEFUSE 3 and SELECT2 thrombectomy trials included some patients with similar radiographic profiles, although the rates of good functional outcomes differed widely between the studies., Objective: To report neurological outcomes for patients who meet CT and CT perfusion (CTP) inclusion criteria common to both DEFUSE 3 and SELECT2., Methods: Retrospective study of thrombectomy patients, presenting between November 2016 and December 2023 to a large health system, with Alberta Stroke Program Early CT score ≥6, core infarction 50-69 mL, mismatch ratio ≥1.8, and mismatch volume ≥15 mL. The primary outcome was 90-day modified Rankin Scale score 0-2. A logistic regression analysis was performed to identify independent predictors of the primary outcome., Results: 85 patients, with mean age 64.6 (16.6) years and median National Institutes of Health Stroke Scale score 18 (15-23), were included. Thirty-eight of 85 patients (44.7%) were functionally independent at 90 days. Predictors of functional independence included age (OR=0.943, 95% CI 0.908 to 0.980; P=0.003), initial glucose (OR=0.989, 95% CI 0.978 to 1.000; P=0.044), and time last known well to skin puncture (OR=0.997, 95% CI 0.994 to 1.000; P=0.028). The area under the curve for the multivariable model predicting the primary outcome was 0.82 (95% CI 0.73 to 0.92)., Conclusion: Nearly half of patients meeting radiographic criteria common to DEFUSE 3 and SELECT2 are functionally independent at 90 days, similar to rates reported for the treated DEFUSE 3 cohort. This might be due to their moderate core volumes and large ischemic penumbra., Competing Interests: Competing interests: JB declares stock/stock options from Viz.Ai and personal fees from Stryker, Terumo, and Rapid AI. JJH is a consultant for Medtronic and MicroVention and a member of the Scientific and Advisory Board for iSchemaView; reports an equity interest in Dragon Medical, Inc. GWA is a consultant for Genentech and iSchemaView, and has equity interest in iSchemaView. AWA is a consultant for iSchemaView. All other authors report no disclosures., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)