ArticleStroke (Hoboken, N.J.)2023
Early Metabolic Alteration Predicts Outcome With Middle Cerebral Artery Occlusion Treated by Mechanical Thrombectomy.
Article in Stroke (Hoboken, N.J.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Predicting clinical outcome based on either the postprocedural recanalization score (modified treatment in cerebral infarction) or the initial National Institute of Health Stroke Scale (NIHSS) clinical score performed immediately after the acute phase remains controversial. The Methods: Patients with proximal middle cerebral artery occlusion, an NIHSS score greater than 6 and successfully treated by mechanical thrombectomy with or without intravenous therapy were included. All patients underwent within 24 hours after mechanical thrombectomy, brain magnetic resonance imaging examination with multivoxel proton-phosphorus-magnetic resonance spectroscopy. Functional disability at 90 days with reference to pre-stroke activities was categorized using the modified Rankin scale. Metabolite ratios were measured and confronted to modified Rankin scale. Results: A total of 49 patients were included with initial mean NIHSS of 15.19±5.48. Time delay between: onset-thrombectomy was 6.77 hours±3.22, thrombectomy-magnetic resonance imaging was 29.83 hours±15.01. Results in the lesion compared with the contralateral area show an increase of Lac/Cr (0.88 versus 0.21; Conclusion: Our study shows that early Lac/Cr alteration visible 24 hours after stroke is a strong predictor of 90 days clinical outcome for middle cerebral artery occlusion patients successfully treated by mechanical thrombectomy. Our NIHSS+proton-magnetic resonance spectroscopy model is the first to predict patients' long-term functional outcome with an accuracy of 85.3%, superior to existing models including diffusion weighted imaging.
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