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Dr. Broocks et al. examined the relationship between net water uptake (NWU), a quantitative CT imaging marker of early lesion water uptake, and functional outcome in a multicenter observational study of 254 patients with large vessel anterior circulation stroke. Patients had extensive early ischemic changes, as reflected by a low Alberta Stroke Program Early CT Score (ASPECTS ≤5 reflecting more regions of involvement). They found that higher early NWU was independently associated with poorer functional outcome, including after recanalization with mechanical thrombectomy, and suggested that NWU might therefore serve as an indicator of futile thrombectomy in patients with low ASPECTS. In response, Dr. Pensato et al. note that the study may have been limited by the use of a region-of-interest (ROI)–based calculation of NWU in a single area within the ischemic lesion. Given the high rates of poor functional outcome seen in recent positive trials of thrombectomy in low ASPECTS stroke, they suggest that combining ASPECTS with NWU calculations in each ASPECTS subregion may help better select patients with extensive ischemic changes who can benefit from thrombectomy. Responding to these comments, the authors agree that the smaller margin of benefit after thrombectomy in patients with large infarcts may be improved by further imaging stratification using NWU in combination with ASPECTS. This exchange highlights the potential added value of quantitative imaging markers, derivable from routine stroke imaging, in improving patient selection for thrombectomy in patients with low ASPECTS.
Dr. Broocks et al. examined the relationship between net water uptake (NWU), a quantitative CT imaging marker of early lesion water uptake, and functional outcome in a multicenter observational study of 254 patients with large vessel anterior circulation stroke. Patients had extensive early ischemic changes, as reflected by a low Alberta Stroke Program Early CT Score (ASPECTS ≤5 reflecting more regions of involvement). They found that higher early NWU was independently associated with poorer functional outcome, including after recanalization with mechanical thrombectomy, and suggested that NWU might therefore serve as an indicator of futile thrombectomy in patients with low ASPECTS. In response, Dr. Pensato et al. note that the study may have been limited by the use of a region-of-interest (ROI)–based calculation of NWU in a single area within the ischemic lesion. Given the high rates of poor functional outcome seen in recent positive trials of thrombectomy in low ASPECTS stroke, they suggest that combining ASPECTS with NWU calculations in each ASPECTS subregion may help better select patients with extensive ischemic changes who can benefit from thrombectomy. Responding to these comments, the authors agree that the smaller margin of benefit after thrombectomy in patients with large infarcts may be improved by further imaging stratification using NWU in combination with ASPECTS. This exchange highlights the potential added value of quantitative imaging markers, derivable from routine stroke imaging, in improving patient selection for thrombectomy in patients with low ASPECTS.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2023 American Academy of Neurology
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