Miran Han MD, Presenter: Nothing to Disclose

Jin Wook Choi MD, Abstract Co-Author: Nothing to Disclose

Sun Yong Kim MD, Abstract Co-Author: Nothing to Disclose

Jin Soo Lee, Abstract Co-Author: Nothing to Disclose

Young Keun Sur MD, Abstract Co-Author: Nothing to Disclose

Seon Young Park MD, Abstract Co-Author: Nothing to Disclose

The recent shift of endovascular treatment (ET) methods for acute ischemic stroke towards better outcome. We hypothesized that bigger core volume may be tolerable to further ET. This study was retrospectively designed to predict the prognosis using ADC volume in endovascular revascularization therapy for acute ischemic stroke.

Patients with acute ischemic stroke in anterior circulation territory and intra-arterial (IA) revascularization therapy were retrieved. ADC volume taken before the IA therapy was calculated quantitatively with the margin thresholds of ADC value as 700x10-5 mm2/s. Futile prognosis was defined as modified Rankin Scale 5-6 at 3 months. We divided patients into 3 groups. Group 1 represented with ADC volume less than 50 cm3, group 2 with 50 to 100 cm3 and group 3 with more than 100 cm3. Baseline characteristics (age, initial NIHSS score), imaging data (successful revascularization, TICI 2a-3) and clinical outcomes (good outcome, mRS 0-2 at 3months; poor outcome, mRS 5-6) were compared among groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were done.

Finally, 76 patients were enrolled in this study. There is no difference of age and successful revascularization among the groups. Larger volume group show significantly high initial NIHSS score (p=0.027) and poor outcome (p < 0.001). ADC volume more than 100 cm3 was significantly associated with futile prognosis (p=0.001, Odds ratio, 25.4 [95%CI, 3.874-166.673]). The area under the ROC curve for ADC volumes was 0.675 (p=0.009). For predicting futile prognosis, sensitivity and specificity were 57.6% and 69.8% at ADC volume 50 cm3, 48.5% and 95.3% at 100 cm3 and 33.3% and 97.7% at 150 cm3, respectively.

A huge DWI volume was associated with the futile prognosis. This imaging marker, however, could not be a single sign for stopping further aggressive IA treatment for acute ischemic stroke because the area under the ROC curve was relatively small. When IA therapy is considered, well known harmful factors including old age, high NIHSS score and huge ADC volume should be combined altogether for ‘no more to go’.

Recent progress of ET methods might be attributed to a tolerance of bigger ADC volume than previously recommended.

Han, M, Choi, J, Kim, S, Lee, J, Sur, Y, Park, S, The Prediction of Prognosis Using ADC Volume in Endovascular Revascularization Therapy for Acute Ischemic Stroke.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018716.html