Clinical application of the modified Pullicino formula in endovascular thrombectomy in acute anterior circulation large cerebral infarction-A two-center retrospective study.

Abstract

Aims: This study aimed to assess whether the modified Pullicino formula could be used as a screening indicator for measuring infarct volume before endovascular thrombectomy (EVT) and observe baseline factors affecting neurological recovery in patients with acute anterior circulation large-core cerebral infarction.

Methods: The Pullicino formula × (1-22 %) was applied to anterior circulation large cerebral infarctions with ASPECTS <6 to screen patients with infarct volumes of 70-150 mL. The outcomes were assessed by mRS score at 90 days, modified Treatment in Cerebral Ischemia (mTICI) score, symptomatic intracranial hemorrhage within 48 h, and death rate within 90 days.

Results: Significantly more patients in the EVT group with infarct volumes 70-150 mL had mRS ≤ 3 at 90 days than did the standard drug therapy (OR, 2.93; 95 % CI, 1.08-7.89, p = 0.03) and a significantly decreased mortality rate (OR, 0.36; 95 % CI, 0.13-0.98; p = 0.04), with 88.2 % in patients with mTICI ≥ 2b. There was no significant difference in the intracranial hemorrhage. EVT (adjusted OR [aOR], 2.84; 95 % CI, 1.15-7.01, p = 0.02), infarct volume <150 mL (aOR, 3.47; 95 % CI, 1.20-10.14, p = 0.02), and intracranial atherosclerosis (aOR, 4.20; 95 % CI, 1.24-14.04, p = 0.02) were significantly associated with patient prognosis.

Conclusions: Without commercial artificial intelligence software, the modified Pullicino formula can be used to calculate infarct volume and, in combination with ASPECTS <6, to select patients who may benefit from EVT.