Malignant infarction after endovascular treatment: Incidence and prediction

Marie Louise E. Bernsen*, Frans Kauw, Jasper M. Martens, Aad van der Lugt, Lonneke S.F. Yo, Marianne A.A. van Walderveen, Yvo B.W.E.M. Roos, H. Bart van der Worp, Jan W. Dankbaar, Jeannette Hofmeijer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Early prediction of malignant infarction may guide treatment decisions. For patients who received endovascular treatment, the risk of malignant infarction is unknown and risk factors are unrevealed. Aims: The objective of this study is to estimate the incidence of malignant infarction after endovascular treatment in patients with an occlusion of the anterior circulation, to identify independent risk factors, and to establish a model for prediction. Methods: We analyzed patients who received endovascular treatment for a large vessel occlusion in the anterior circulation within 6.5 h after symptom onset, included in the Dutch MR CLEAN Registry between March 2014 and June 2016. We compared patients with and without malignant infarction. Candidate predictors were incorporated in a multivariable binary logistic regression model. The final prediction model was established using backward elimination. Discrimination and calibration were evaluated with the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test. Results: Of 1445 patients, 82 (6%) developed malignant infarction. Independent predictors were lower age, higher National Institutes of Health Stroke Scale (NIHSS), lower alberta stroke program early CT score (ASPECTS), internal carotid artery occlusion, lower collateral score, longer times from onset to groin puncture, and unsuccessful reperfusion. The AUROC of a prediction model combining these features was 0.83 (95% confidence interval (CI): 0.79–0.88) and the Hosmer-Lemeshow test indicated appropriate calibration (P = 0.937). Conclusion: The risk of malignant infarction after endovascular treatment started within 6.5 h of stroke onset is approximately 6%. Successful reperfusion decreases the risk. A prediction model combining easily retrievable measures of age, ASPECTS, collateral status, and reperfusion shows good discrimination between patients who will develop malignant infarction and those who will not.

Original languageEnglish
Pages (from-to)198-206
Number of pages9
JournalInternational Journal of Stroke
Volume17
Issue number2
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was partly funded by the TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center (MUMC), and Academic Medical Center (AMC), Amsterdam. Erasmus MC received funds from Stryker® and Bracco Imaging®. AMC received funds from Stryker®. MUMC received funds from Stryker® and Codman®. HBvdW received funds paid to his institution from Bayer, Boehringer Ingelheim, and LivaNova for consultancy and from Stryker paid to the CONTRAST consortium.

Funding Information:
We would like to thank the MR CLEAN investigators (see Supplementary Material). The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was partly funded by the TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center (MUMC), and Academic Medical Center (AMC), Amsterdam. Erasmus MC received funds from Stryker? and Bracco Imaging?. AMC received funds from Stryker?. MUMC received funds from Stryker? and Codman?. HBvdW received funds paid to his institution from Bayer, Boehringer Ingelheim, and LivaNova for consultancy and from Stryker paid to the CONTRAST consortium.

Publisher Copyright:
© 2021 World Stroke Organization.

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