Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort
IntroductionTo investigate the independent prognostic risk factors in acute ischemic stroke patients with large-core infarcts, including patients beyond standard eligibility thresholds for core volume or ASPECTS and provide evidence for early clinical intervention.MethodsThis retrospective cohort st...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1595054/full |
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| author | Yi Li Yi Li Hao Tao Hao Tao Huan Liu Huan Liu Xiang Fan Xiang Fan Meng-Yu Zhong Meng-Yu Zhong Jie Huang Neng-Wei Yu Neng-Wei Yu Bing-Hu Li Bing-Hu Li |
| author_facet | Yi Li Yi Li Hao Tao Hao Tao Huan Liu Huan Liu Xiang Fan Xiang Fan Meng-Yu Zhong Meng-Yu Zhong Jie Huang Neng-Wei Yu Neng-Wei Yu Bing-Hu Li Bing-Hu Li |
| author_sort | Yi Li |
| collection | DOAJ |
| description | IntroductionTo investigate the independent prognostic risk factors in acute ischemic stroke patients with large-core infarcts, including patients beyond standard eligibility thresholds for core volume or ASPECTS and provide evidence for early clinical intervention.MethodsThis retrospective cohort study analyzed the clinical data of 96 consecutive patients with large-core infarcts admitted to a regional stroke center between June 2020 and June 2024. Participants were stratified into poor outcome [modified Rankin Scale (mRS) 4–6] and favorable outcome (mRS 0–3) groups based on the 90-day post-intervention assessments. Comparative analyses of the baseline demographics, biochemical parameters, neuroimaging metrics, and treatment modalities were conducted. Univariate analysis followed by multivariate logistic regression was used to identify independent predictors of favorable outcome. A prespecified EVT subgroup analysis was performed, including procedural variables (onset-to-puncture time, puncture-to-recanalization time) and clinical variables in multivariate regression.ResultsAmong the 96 patients, 17 (17.7%) achieved favorable outcomes (mRS 0–3) and 79 (82.3%) had poor outcomes (mRS 4–6). Multivariable analysis identified four independent predictors of poor outcome: non-receipt of EVT [OR = 10.22, 95% confidence interval (CI): 1.05–99.76], hyperglycemia (per 1 mmol/L; OR = 1.76, 95% CI: 1.10–2.82), and higher platelet count (per 103/μL; OR = 1.02, 95% CI: 1.00–1.03) (all p < 0.05). In the EVT subgroup (n = 62), hyperglycemia remained significantly associated with poor outcomes (OR = 1.70, 95% CI: 1.04–2.78, p = 0.034).ConclusionEVT significantly improves functional outcomes in large-core infarcts. Preoperative hyperglycemia and elevated platelet count are independent predictors of poor outcomes. These findings support standardized protocols that integrate early EVT with glycemic control and coagulation monitoring in this patient population. |
| format | Article |
| id | doaj-art-e8751f5791be4d96a62943f8228636ec |
| institution | OA Journals |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-06-01 |
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| series | Frontiers in Neurology |
| spelling | doaj-art-e8751f5791be4d96a62943f8228636ec2025-08-20T02:32:20ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-06-011610.3389/fneur.2025.15950541595054Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohortYi Li0Yi Li1Hao Tao2Hao Tao3Huan Liu4Huan Liu5Xiang Fan6Xiang Fan7Meng-Yu Zhong8Meng-Yu Zhong9Jie Huang10Neng-Wei Yu11Neng-Wei Yu12Bing-Hu Li13Bing-Hu Li14School of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaSchool of Clinical Medicine, Southwest Medical University, Luzhou, ChinaSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaSchool of Clinical Medicine, Southwest Medical University, Luzhou, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, ChinaDepartment of Neurology, Sichuan Provincial People’s Hospital, Chengdu, ChinaIntroductionTo investigate the independent prognostic risk factors in acute ischemic stroke patients with large-core infarcts, including patients beyond standard eligibility thresholds for core volume or ASPECTS and provide evidence for early clinical intervention.MethodsThis retrospective cohort study analyzed the clinical data of 96 consecutive patients with large-core infarcts admitted to a regional stroke center between June 2020 and June 2024. Participants were stratified into poor outcome [modified Rankin Scale (mRS) 4–6] and favorable outcome (mRS 0–3) groups based on the 90-day post-intervention assessments. Comparative analyses of the baseline demographics, biochemical parameters, neuroimaging metrics, and treatment modalities were conducted. Univariate analysis followed by multivariate logistic regression was used to identify independent predictors of favorable outcome. A prespecified EVT subgroup analysis was performed, including procedural variables (onset-to-puncture time, puncture-to-recanalization time) and clinical variables in multivariate regression.ResultsAmong the 96 patients, 17 (17.7%) achieved favorable outcomes (mRS 0–3) and 79 (82.3%) had poor outcomes (mRS 4–6). Multivariable analysis identified four independent predictors of poor outcome: non-receipt of EVT [OR = 10.22, 95% confidence interval (CI): 1.05–99.76], hyperglycemia (per 1 mmol/L; OR = 1.76, 95% CI: 1.10–2.82), and higher platelet count (per 103/μL; OR = 1.02, 95% CI: 1.00–1.03) (all p < 0.05). In the EVT subgroup (n = 62), hyperglycemia remained significantly associated with poor outcomes (OR = 1.70, 95% CI: 1.04–2.78, p = 0.034).ConclusionEVT significantly improves functional outcomes in large-core infarcts. Preoperative hyperglycemia and elevated platelet count are independent predictors of poor outcomes. These findings support standardized protocols that integrate early EVT with glycemic control and coagulation monitoring in this patient population.https://www.frontiersin.org/articles/10.3389/fneur.2025.1595054/fullendovascular therapylarge-core infarctsprognostic determinantshyperglycemiathrombocytosis |
| spellingShingle | Yi Li Yi Li Hao Tao Hao Tao Huan Liu Huan Liu Xiang Fan Xiang Fan Meng-Yu Zhong Meng-Yu Zhong Jie Huang Neng-Wei Yu Neng-Wei Yu Bing-Hu Li Bing-Hu Li Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort Frontiers in Neurology endovascular therapy large-core infarcts prognostic determinants hyperglycemia thrombocytosis |
| title | Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort |
| title_full | Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort |
| title_fullStr | Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort |
| title_full_unstemmed | Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort |
| title_short | Endovascular therapy and medical management of large-core infarcts: prognostic determinants in a retrospective cohort |
| title_sort | endovascular therapy and medical management of large core infarcts prognostic determinants in a retrospective cohort |
| topic | endovascular therapy large-core infarcts prognostic determinants hyperglycemia thrombocytosis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1595054/full |
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