Outcome estimation based on multimodal computed tomography examination in acute ischaemic stroke patients treated with mechanical thrombectomy

Introduction: Reperfusion therapy for acute ischaemic stroke used within a time window of 6 h following symptom onset, although currently the treatment of choice, is characterised by certain limitations and carries certain risks.

Aim: To assess the potential for predicting the risks and limitations of reperfusion therapy by means of advanced neuroimaging.

Material and methods: For this purpose, the baseline CT scans of patients with ischaemic stroke treated by means of mechanical thrombectomy were assessed retrospectively using the Combined Multimodal Computed Tomography Score (CMCTS), modified to account for the perfusion examination of a limited area. These data were then combined with radiological and clinical outcomes, in particular haemorrhagic stroke transformation and scoring on a modified Rankin scale (mRS).

Results: Based on material from 85 patients, the scoring system we employed enabled us to distinguish a group that did not benefit from treatment with specificity and a positive predictive value of 100%, and a negative predictive value of 64%. Neither the relationship between the score and early haemorrhagic complications, nor the effectiveness or severity of the course of the thrombectomy procedure itself was confirmed.

Conclusions: There is no justification for the use of reperfusion procedures in acute ischaemic stroke in the anterior circulation in patients with initially unfavourable multimodal computed tomography scores.