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Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0–5 Treated by Thrombectomy

Diffusion Weighted Imaging Reversal in Large Volume Stroke

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Abstract

Purpose

To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0–5 treated with thrombectomy, and to determine its predictors in current practice.

Methods

We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0–5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr.

Results

Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2–7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1–4.6; p 0.030). Only successful recanalization (mTICI 2c–3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3–7.9; p 0.009).

Conclusion

The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0–5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c–3 recanalization emerged as an independent DWIr predictor.

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Members of the Endovascular Treatment in Ischemic Stroke (ETIS) Investigators

Rothschild Foundation: Michel Piotin; Raphael Blanc; Hocine Redjem; Simon Escalard; Jean-Philippe Dessilles; François Delvoye; Stanislas Smajda; Benjamin Maier; Hebert Solène; Mikael Mazighi; Mikael Obadia; Candice Sabben; Pierre Seners; Igor Raynouard; Ovide Corabianu; Thomas de Broucker; Eric Manchon; Guillaume Taylor; Malek Ben Maacha; Laurie-Anne Thion; Augustin Lecler; Julien Savatovsky. Foch Hospital: Adrien Wang; Serge Evrard; Maya Tchikviladze; Nadia Ajili; Bertrand Lapergue; David Weisenburger-Lile; Lucas Gorza; Géraldine Buard; Oguzhan Coskun; Arturo Consoli; Federico Di Maria; Georges Rodesch; Sergio Zimatore; Morgan Leguen; Julie Gratieux; Fernando Pico; Haja Rakotoharinandrasana; Philippe Tassan; Roxanna Poll; Sylvie Marinier. CHU Bordeaux: Gaultier Marnat; Florent Gariel; Xavier Barreau; Jérôme Berge; Patrice Menegon; Igor Sibon; Ludovic Lucas; Stéphane Olindo; Pauline Renou; Sharmila Sagnier; Mathilde Poli; Sabrina Debruxelles; François Rouanet; Thomas Tourdias; Jean-Sebastien Liegey; Pierre Briau; Nicolas Pangon. CHU Nantes: Romain Bourcier; Lili Detraz; Benjamin Daumas-Duport; Pierre-Louis Alexandre; Monica Roy; Cédric Lenoble; Hubert Desal; Benoît Guillon; Solène de Gaalon; Cécile Preterre. CHRU-Nancy: Benjamin Gory; Serge Bracard; René Anxionnat; Marc Braun; Anne-Laure Derelle; Romain Tonnelet; Liang Liao; François Zhu; Emmanuelle Schmitt; Sophie Planel; Sébastien Richard; Lisa Humbertjean; Gioia Mione; Jean-Christophe Lacour; Gérard Audibert; Marcela Voicu; Lionel Alb; Marie Reitter; Madalina Brezeanu; Agnès Masson; Adriana Tabarna; Iona Podar; Pauline Bourst; Sarah Guy; Fatiha Bechiri. CHU Limoges: Francisco Macian-Montoro; Suzanna Saleme; Charbel Mounayer; Aymeric Rouchaud; Laetitia Gimenez; Alexandre Cosnard. CHRU Gui de Chauliac: Vincent Costalat; Caroline Arquizan; Cyril Dargazanli; Grégory Gascou; Pierre-Henri Lefèvre; Imad Derraz; Carlos Riquelme; Nicolas Gaillard; Isabelle Mourand; Lucas Corti; Federico Cagnazzo; Adrien ter Schiphorst. CHU Rennes: Francois Eugene; Stéphane Vannier; Jean-Christophe Ferre; Hélène Raoult; Thomas Ronziere; Maria Lassale; Christophe Paya; Jean-Yves Gauvrit; Clément Tracol; Sophie Langnier-Lemercier; Axelle Maurice; Sabrina Cochennec; Mélanie Pinault. CHU Pitié-Salpétrière: Frédéric Clarençon; Eimad Shotar; Nader Sourour; Stéphanie Lenck; Kévin Premat; Yves Samson; Anne Léger; Sophie Crozier; Flore Baronnet; Sonia Alamowitch; Laure Bottin; Mathon Yger; Vincent Degos. CHU Kremlin-Bicêtre: Laurent Spelle; Christian Denier; Olivier Chassin; Vanessa Chalumeau; Jildaz Caroff; Olivier Chassin; Laura Venditti; Mariana Sarov; Nicolas Legris. Hôpital Saint-Anne: Olivier Naggara; Wagih Ben Hassen; Grégoire Boulouis; Christine Rodriguez-Régent; Denis Trystram; Basile Kerleroux; Guillaume Turc; Valérie Domigo; Catherine Lamy; Julia Birchenall; Clothilde Isabel; François Lun. CHU Toulouse: Alain Viguier; Christophe Cognard; Anne-Christine Januel; Jean-Marc Olivot; Louis Fontaine; Nicolas Raposo; Fabrice Bonneville; Jean-François Albucher; Lionel Calviere; Jean Darcourt; Guillaume Bellanger; Philippe Tall. CHU Caen: Emmanuel Touze; Charlotte Barbier; Romain Schneckenburger; Marion Boulanger; Julien Cogez; Sophie Guettier; Maxime Gauberti. CHU Brest: Serge Timsit; Jean-Christophe Gentric; Julien Ognard; Francois Mathias Merrien. CHU Rouen: Ozlem Ozku Wermester; Evelyne Massardier; Chrisanthi Papagiannaki; Aude Triquenot; Margeaux Lefebvre. CH Bayonne: Frédéric Bourdain; Patricia Bernady; Laurent Lagoarde-Segot; Hélène Cailliez; Louis Veunac; David Higue. CHU Strasbourg: Valérie Wolff; Veronique Quenardelle; Valerie Lauer; Roxana Gheoca; Irene Pierre-Paul; Raoul Pop; Remy Beaujeux; Dan Mihoc; Monica Manisor; Julien Pottecher; Alain Meyer; Thiên-Nga Chamaraux-Tran. CH Vannes: Anthony Le Bras; Sarah Evain; Arnaud Le Guen.

Acknowledgements

We thank Mary Osborne-Pellegrin for her help in editing the final draft of the article

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy

    Pietro Panni

  2. Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France

    Bertrand Lapergue

  3. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France

    Benjamin Maïer & Romain Bourcier

  4. AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Stephanos Finitsis

  5. Department of Neuroradiology, CHU Pitié-Salpétrière, Paris, France

    Frédéric Clarençon

  6. CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine, 54000, Nancy, France

    Sébastien Richard

  7. CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France

    Sébastien Richard

  8. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France

    Gaultier Marnat

  9. Neurology, University Hospital of Bordeaux, Bordeaux, France

    Igor Sibon

  10. Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France

    Cyril Dargazanli

  11. Department of Neuroradiology, University Hospital of Nantes, Nantes, France

    Raphaël Blanc

  12. Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France

    Arturo Consoli

  13. Department of Neuroradiology, University Hospital of Rennes, Rennes, France

    François Eugène

  14. Neurology, University Hospital of Rennes, Rennes, France

    Stéphane Vannier

  15. Neuroradiology, CHU Kremlin Bicêtre, Paris, France

    Laurent Spelle

  16. Department of Neurology, CHU Kremlin Bicêtre, Paris, France

    Christian Denier

  17. Department of Neurology, CHU Caen, Caen, France

    Marion Boulanger

  18. Neuroradiology, CHU Caen, Caen, France

    Maxime Gauberti

  19. Neuroradiology, CHU Limoges, Limoges, France

    Suzana Saleme

  20. Department of Neurology, CHU Limoges, Limoges, France

    Francisco Macian

  21. Department of Neurology, CHU Pitié-Salpétrière, Paris, France

    Charlotte Rosso

  22. Neuroradiology, Hôpital Saint-Anne, Paris, France

    Olivier Naggara

  23. Department of Neurology, Hôpital Saint-Anne, Paris, France

    Guillaume Turc

  24. Department of Neurology, CHU Rouen, Rouen, France

    Ozlem Ozkul-Wermester

  25. Neuroradiology, CHU Rouen, Rouen, France

    Chrisanthi Papagiannaki

  26. Department of Neurology, CHU Toulouse, Toulouse, France

    Jean-François Albucher

  27. Neuroradiology, CHU Toulouse, Toulouse, France

    Jean Darcourt

  28. Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France

    Anthony Le Bras

  29. Neurology, CHBA Bretagne Atlantique, Vannes, France

    Sarah Evain

  30. Department of Neurology, CHU Strasbourg, Strasbourg, France

    Valérie Wolff

  31. Neuroradiology, CHU Strasbourg, Strasbourg, France

    Raoul Pop

  32. Department of Neurology, CHU Brest, Brest, France

    Serge Timsit

  33. Neuroradiology, CHU Brest, Brest, France

    Jean-Christophe Gentric

  34. Department of Neurology, CH Côte Basque, Bayonne, France

    Frédéric Bourdain

  35. Neuroradiology, CH Côte Basque, Bayonne, France

    Louis Veunac

  36. Neurology, CHRU Gui de Chauliac, Montpellier, France

    Caroline Arquizan

  37. CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, 54000, Nancy, France

    Benjamin Gory

  38. IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France

    Benjamin Gory

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  1. Pietro Panni
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  2. Bertrand Lapergue
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  3. Benjamin Maïer
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  4. Stephanos Finitsis
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  5. Frédéric Clarençon
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  6. Sébastien Richard
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  7. Gaultier Marnat
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  8. Romain Bourcier
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  9. Igor Sibon
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  10. Cyril Dargazanli
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Consortia

ETIS (Endovascular Treatment in Ischemic Stroke) investigators

  • Michel Piotin
  • , Raphael Blanc
  • , Hocine Redjem
  • , Simon Escalard
  • , Jean-Philippe Dessilles
  • , François Delvoye
  • , Stanislas Smajda
  • , Benjamin Maier
  • , Hebert Solène
  • , Mikael Mazighi
  • , Mikael Obadia
  • , Candice Sabben
  • , Pierre Seners
  • , Igor Raynouard
  • , Ovide Corabianu
  • , Thomas de Broucker
  • , Eric Manchon
  • , Guillaume Taylor
  • , Malek Ben Maacha
  • , Laurie-Anne Thion
  • , Augustin Lecler
  • , Julien Savatovsky
  • , Adrien Wang
  • , Serge Evrard
  • , Maya Tchikviladze
  • , Nadia Ajili
  • , Bertrand Lapergue
  • , David Weisenburger-Lile
  • , Lucas Gorza
  • , Géraldine Buard
  • , Oguzhan Coskun
  • , Arturo Consoli
  • , Federico Di Maria
  • , Georges Rodesch
  • , Sergio Zimatore
  • , Morgan Leguen
  • , Julie Gratieux
  • , Fernando Pico
  • , Haja Rakotoharinandrasana
  • , Philippe Tassan
  • , Roxanna Poll
  • , Sylvie Marinier
  • , Gaultier Marnat
  • , Florent Gariel
  • , Xavier Barreau
  • , Jérôme Berge
  • , Patrice Menegon
  • , Igor Sibon
  • , Ludovic Lucas
  • , Stéphane Olindo
  • , Pauline Renou
  • , Sharmila Sagnier
  • , Mathilde Poli
  • , Sabrina Debruxelles
  • , François Rouanet
  • , Thomas Tourdias
  • , Jean-Sebastien Liegey
  • , Pierre Briau
  • , Nicolas Pangon
  • , Romain Bourcier
  • , Lili Detraz
  • , Benjamin Daumas-Duport
  • , Pierre-Louis Alexandre
  • , Monica Roy
  • , Cédric Lenoble
  • , Hubert Desal
  • , Benoît Guillon
  • , Solène de Gaalon
  • , Cécile Preterre
  • , Benjamin Gory
  • , Serge Bracard
  • , René Anxionnat
  • , Marc Braun
  • , Anne-Laure Derelle
  • , Romain Tonnelet
  • , Liang Liao
  • , François Zhu
  • , Emmanuelle Schmitt
  • , Sophie Planel
  • , Sébastien Richard
  • , Lisa Humbertjean
  • , Gioia Mione
  • , Jean-Christophe Lacour
  • , Gérard Audibert
  • , Marcela Voicu
  • , Lionel Alb
  • , Marie Reitter
  • , Madalina Brezeanu
  • , Agnès Masson
  • , Adriana Tabarna
  • , Iona Podar
  • , Pauline Bourst
  • , Sarah Guy
  • , Fatiha Bechiri
  • , Francisco Macian-Montoro
  • , Suzanna Saleme
  • , Charbel Mounayer
  • , Aymeric Rouchaud
  • , Laetitia Gimenez
  • , Alexandre Cosnard
  • , Vincent Costalat
  • , Caroline Arquizan
  • , Cyril Dargazanli
  • , Grégory Gascou
  • , Pierre-Henri Lefèvre
  • , Imad Derraz
  • , Carlos Riquelme
  • , Nicolas Gaillard
  • , Isabelle Mourand
  • , Lucas Corti
  • , Federico Cagnazzo
  • , Adrien ter Schiphorst
  • , Francois Eugene
  • , Stéphane Vannier
  • , Jean-Christophe Ferre
  • , Hélène Raoult
  • , Thomas Ronziere
  • , Maria Lassale
  • , Christophe Paya
  • , Jean-Yves Gauvrit
  • , Clément Tracol
  • , Sophie Langnier-Lemercier
  • , Axelle Maurice
  • , Sabrina Cochennec
  • , Mélanie Pinault
  • , Frédéric Clarençon
  • , Eimad Shotar
  • , Nader Sourour
  • , Stéphanie Lenck
  • , Kévin Premat
  • , Yves Samson
  • , Anne Léger
  • , Sophie Crozier
  • , Flore Baronnet
  • , Sonia Alamowitch
  • , Laure Bottin
  • , Mathon Yger
  • , Vincent Degos
  • , Laurent Spelle
  • , Christian Denier
  • , Olivier Chassin
  • , Vanessa Chalumeau
  • , Jildaz Caroff
  • , Olivier Chassin
  • , Laura Venditti
  • , Mariana Sarov
  • , Nicolas Legris
  • , Olivier Naggara
  • , Wagih Ben Hassen
  • , Grégoire Boulouis
  • , Christine Rodriguez-Régent
  • , Denis Trystram
  • , Basile Kerleroux
  • , Guillaume Turc
  • , Valérie Domigo
  • , Catherine Lamy
  • , Julia Birchenall
  • , Clothilde Isabel
  • , François Lun
  • , Alain Viguier
  • , Christophe Cognard
  • , Anne-Christine Januel
  • , Jean-Marc Olivot
  • , Louis Fontaine
  • , Nicolas Raposo
  • , Fabrice Bonneville
  • , Jean-François Albucher
  • , Lionel Calviere
  • , Jean Darcourt
  • , Guillaume Bellanger
  • , Philippe Tall
  • , Emmanuel Touze
  • , Charlotte Barbier
  • , Romain Schneckenburger
  • , Marion Boulanger
  • , Julien Cogez
  • , Sophie Guettier
  • , Maxime Gauberti
  • , Serge Timsit
  • , Jean-Christophe Gentric
  • , Julien Ognard
  • , Francois Mathias Merrien
  • , Ozlem Ozku Wermester
  • , Evelyne Massardier
  • , Chrisanthi Papagiannaki
  • , Aude Triquenot
  • , Margeaux Lefebvre
  • , Frédéric Bourdain
  • , Patricia Bernady
  • , Laurent Lagoarde-Segot
  • , Hélène Cailliez
  • , Louis Veunac
  • , David Higue
  • , Valérie Wolff
  • , Veronique Quenardelle
  • , Valerie Lauer
  • , Roxana Gheoca
  • , Irene Pierre-Paul
  • , Raoul Pop
  • , Remy Beaujeux
  • , Dan Mihoc
  • , Monica Manisor
  • , Julien Pottecher
  • , Alain Meyer
  • , Thiên-Nga Chamaraux-Tran
  • , Anthony Le Bras
  • , Sarah Evain
  •  & Arnaud Le Guen

Corresponding author

Correspondence to Pietro Panni.

Ethics declarations

Conflict of interest

P. Panni, B. Lapergue, B. Maïer, S. Finitsis, F. Clarençon, S. Richard, G. Marnat, R. Bourcier, I. Sibon, C. Dargazanli, R. Blanc, A. Consoli, F. Eugène, S. Vannier, L. Spelle, C. Denier, M. Boulanger, M. Gauberti, S. Saleme, F. Macian, C. Rosso, O. Naggara, G. Turc, O. Ozkul-Wermester, C. Papagiannaki, J.-F. Albucher, J. Darcourt, A. Le Bras, S. Evain, V. Wolff, R. Pop, S. Timsit, J.‑C. Gentric, F. Bourdain, L. Veunac, C. Arquizan and B. Gory declare that they have no competing interests.

Additional information

This article is published by all authors on behalf of Endovascular Treatment in Ischemic Stroke (ETIS) investigators. A list of ETIS Investigators is given at the end of the article.

Supplementary Information

62_2022_1156_MOESM1_ESM.docx

Supplementary Table 1: Outcome predictors: bivariate comparison of factors associated with 3-months functional independence (mRS 0‑2 VS 3‑6)

62_2022_1156_MOESM2_ESM.tiff

Online Resource Figure 1: Panel a represents baseline DWI showing involvement of both M3 and posterior limb of internal capsule region. Panel b shows partial but incomplete reversal of baseline DWI lesion. This patient was not classified as having DWIr

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Panni, P., Lapergue, B., Maïer, B. et al. Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0–5 Treated by Thrombectomy. Clin Neuroradiol 32, 939–950 (2022). https://doi.org/10.1007/s00062-022-01156-z

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  • DOI: https://doi.org/10.1007/s00062-022-01156-z

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