Deans' stroke musings: Evaluation of Large Ischemic Cores to Predict Outcomes of Thrombectomy: A Proposal of a Novel Treatment Phase

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, February 19, 2024

Evaluation of Large Ischemic Cores to Predict Outcomes of Thrombectomy: A Proposal of a Novel Treatment Phase

Why the fuck are you predicting outcomes rather than delivering 100% recovery? DON'T YOU KNOW SURVIVORS WANT 100% RECOVERY?

Evaluation of Large Ischemic Cores to Predict Outcomes of Thrombectomy: A Proposal of a Novel Treatment Phase

Hirotsugu Ohta and

Originally published16 Feb 2024https://doi.org/10.1161/SVIN.123.001293Stroke: Vascular and Interventional Neurology. 2024;0:e001293

Abstract

BACKGROUND

Endovascular treatment of large ischemic cores is challenging. The severity of ischemic stress is assessed using the apparent diffusion coefficient (ADC). We aimed to evaluate the ADC in patients with a low Alberta Stroke Program Early CT [Computed Tomography] Score using diffusion‐weighted imaging and whether it correlates with clinical outcomes.

METHODS

This study included consecutive patients with acute large ischemic stroke (Alberta Stroke Program Early CT Score‐diffusion‐weighted imaging ≤5) who underwent endovascular treatment with successful recanalization between April 2014 and March 2023. The most frequent ADC (peak ADC) and diffusion‐weighted imaging lesion volumes were assessed. The primary outcome was the 3‐month modified Rankin Scale (mRS) score. Good (mRS score, 0–3) and poor clinical outcomes (mRS score, 4–6) were compared to confirm whether ADC was associated with clinical outcomes.

RESULTS

In total, 78 patients were enrolled in this study; 30 had an mRS score of 0 to 3 at 3 months. The peak ADC in these patients was significantly higher than that in patients with mRS scores of 4 to 6 (P = 0.0002). In multivariate analysis, peak ADC was strongly associated with good clinical outcomes (odds ratio, 1.231; P = 0.0135) rather than onset‐to‐recanalization time and ischemic core volume. The optimal peak ADC threshold for discriminating between the mRS groups was 520×10⁻⁶ mm²/s with a sensitivity of 75% and a specificity of 73%. Good clinical outcomes were more frequently observed in patients with peak ADC ≥520×10⁻⁶ mm²/s (P<0.0001).

CONCLvUSION

In large ischemic cores, diffusion‐weighted imaging lesions with peak ADCs ≥520×10⁻⁶ mm²/s are associated with favorable outcomes.(Favorable to survivors is 100% recovery! GET THERE!) Evaluation of the ischemic core is necessary to confirm endovascular treatment.