Glucose and cerebral blood volume index as predictors of ambulatory function for patients presenting with ultra‐large core infarctions

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Abstract Background and Purpose Acute stroke patients with large core infarctions have poor neurological outcomes, irrespective of treatment. While thrombectomy has efficacy, subsets of large core patients were under‐represented in recently reported clinical trials. Methods Retrospective analysis of patients presenting to a large health system between January 2023 and May 2024 with an anterior circulation large vessel occlusion and computed tomography perfusion (CTP) core infarction ≥ 100 milliliters (mL). We studied predictors of independent ambulatory function at discharge (modified Rankin Scale [mRS] score: 0–3) by performing a multivariable logistic regression analysis. We also report functional outcomes in patients treated with thrombectomy versus medical management. Results Fifty‐five patients (mean age 64.7 [± 15] years, median National Institutes of Health Stroke Scale [NIHSS]: 21 [18–24]) met inclusion criteria. Median core and mismatch volumes were 127 mL (115–170 mL) and 84 mL (45–115 mL), respectively. Initial glucose (per 1‐point increase in milligrams/deciliter, OR: 0.973, 95% CI: 0.939–0.996, p = .049) and CTP cerebral blood volume (CBV) index (per 0.1‐unit increase, OR 2.138, 95% CI: 1.203–4.405, p = .018) independently predicted discharge mRS score 0–3. Treatment with thrombectomy did not predict the primary outcome. Conclusions In our series, lower presenting glucose and more favorable CTP CBV index predicted independent discharge ambulatory function in patients with core infarctions ≥ 100 mL, while thrombectomy did not. These factors may inform treatment teams and serve as selection tools in future studies of under‐represented patients in recently reported large core thrombectomy clinical trials.

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