• Marc Ribo, Alejandro Tomasello, Miguel Lemus, Marta Rubiera, Carla Vert, Alan Flores, Pilar Coscojuela, Jorge Pagola, David Rodriguez-Luna, Sandra Bonet, Marian Muchada, Alex Rovira, and Carlos A Molina.
• From the Stroke Unit, Department of Neurology (M. Ribo, M. Rubiera, A.F., P.C., J.P., D.R.-L., S.B., M.M., C.A.M.) and Neuroradiology, Department of Radiology (A.T., M.L., C.V., A.R.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. marcriboj@hotmail.com.
• Stroke. 2015 Oct 1; 46 (10): 2849-52.

Background And PurposeMultiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM).MethodsWe studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume-computed tomography perfusion or diffusion weighted imaging-magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is <10%.ResultsFifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume was 28±22 mL, and recanalization thrombolysis in cerebral ischemia 2b-3 was 77%. At 24 hours, mean infarct volume was 64±97 mL, and at 3 months modified Rankin Scale 0 to 2 was 45%. Median lesion growth was smaller in recanalizers (16.7% versus 198.3%; P<0.01). MALCOM was 39 mL. When recanalization was achieved, 64% of patients within MALCOM (<39 mL) achieved favorable outcome, whereas despite recanalization only 12% of patients beyond MALCOM (>39 mL) achieved modified Rankin Scale 0 to 2 (P=0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having admission core lesion below MALCOM (OR: 9.3, 95% CI: 1.9-46.4; P<0.01). Analysis according to imaging modality showed that computed tomography-cerebral blood volume allowed larger MALCOM (42 mL) than magnetic resonance-diffusion weighted imaging (29 mL). In octogenarians, MALCOM (15 mL) was lower in younger patients (40 mL).ConclusionsAdmission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures.© 2015 American Heart Association, Inc.

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