Manabu Inoue1, Jean-Marc Olivot1, Julien Labreuche1, Michael Mlynash1, Waimea Tai1, Jean-François Albucher1, Elena Meseguer1, Pierre Amarenco1, Mikael Mazighi2. 1. From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.). 2. From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.). mikael.mazighi@bch.aphp.fr.
Abstract
BACKGROUND AND PURPOSE: In acute ischemic stroke patients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization. METHODS: We analyzed data collected between April 2007 and March 2013 in a prospective clinical registry of acute ischemic stroke patients treated by endovascular approach. Every patient with a documented internal carotid artery or middle cerebral artery occlusion who underwent an acute DWI-MRI before treatment was eligible for this study. The primary outcome was a favorable outcome defined by modified Rankin Scale of 0 to 2 at 90 days. RESULTS: Two hundred ten patients were included and median DWI-ASPECTS was 7 (interquartile range, 4-8). DWI-ASPECTS≥5 was the optimal threshold to predict a favorable outcome (area under the curve=0.69; sensitivity, 90%; specificity, 38%). In a multivariate analysis including confounding variables, the adjusted odds ratio for favorable outcomes associated with a DWI-ASPECTS of ≥5 was 5.06 (95% confidence interval, 1.86-13.77; P=0.002). Nonetheless, the occurrence of a complete recanalization was associated with an increased rate of favorable outcomes in patients with DWI-ASPECTS under 5 (50% versus 3%, P<0.001). CONCLUSIONS: DWI-ASPECTS≥5 seems to be the optimal threshold to predict favorable outcomes among patients undergoing endovascular reperfusion within 6 hours. Selected patients with a DWI-ASPECTS of <5 may still benefit when a complete reperfusion is achieved.
BACKGROUND AND PURPOSE: In acute ischemic strokepatients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization. METHODS: We analyzed data collected between April 2007 and March 2013 in a prospective clinical registry of acute ischemic strokepatients treated by endovascular approach. Every patient with a documented internal carotid artery or middle cerebral artery occlusion who underwent an acute DWI-MRI before treatment was eligible for this study. The primary outcome was a favorable outcome defined by modified Rankin Scale of 0 to 2 at 90 days. RESULTS: Two hundred ten patients were included and median DWI-ASPECTS was 7 (interquartile range, 4-8). DWI-ASPECTS≥5 was the optimal threshold to predict a favorable outcome (area under the curve=0.69; sensitivity, 90%; specificity, 38%). In a multivariate analysis including confounding variables, the adjusted odds ratio for favorable outcomes associated with a DWI-ASPECTS of ≥5 was 5.06 (95% confidence interval, 1.86-13.77; P=0.002). Nonetheless, the occurrence of a complete recanalization was associated with an increased rate of favorable outcomes in patients with DWI-ASPECTS under 5 (50% versus 3%, P<0.001). CONCLUSIONS: DWI-ASPECTS≥5 seems to be the optimal threshold to predict favorable outcomes among patients undergoing endovascular reperfusion within 6 hours. Selected patients with a DWI-ASPECTS of <5 may still benefit when a complete reperfusion is achieved.
Authors: H Kuang; M Najm; D Chakraborty; N Maraj; S I Sohn; M Goyal; M D Hill; A M Demchuk; B K Menon; W Qiu Journal: AJNR Am J Neuroradiol Date: 2018-11-29 Impact factor: 3.825
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Thomas G Devlin; Demetrius K Lopes; Vivek Reddy; Richard du Mesnil de Rochemont; Reza Jahan Journal: Int J Stroke Date: 2015-04 Impact factor: 5.266
Authors: Miran Han; Jin Wook Choi; Nae-Jung Rim; Sun Yong Kim; Hong-Il Suh; Kyu Sun Lee; Ji Man Hong; Jin Soo Lee Journal: Medicine (Baltimore) Date: 2016-08 Impact factor: 1.889