K Wasser1, P Papanagiotou2, F Brunner3, H Hildebrandt3, M Winterhalter4, C Roth2, A Kastrup5. 1. Department of Neurology, University of Göttingen, Göttingen, Germany. 2. Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany. 3. Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany. 4. Department of Anesthesiology, Klinikum Bremen-Mitte, Bremen, Germany. 5. Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany. akastru@gwdg.de.
Abstract
BACKGROUND AND PURPOSE: Endovascular therapy (ET) is superior to intravenous thrombolysis (IVT) in selected patients with anterior circulation large vessel occlusions. However, it is unclear if this positive effect also applies to patients with extensive early ischaemic changes. The aim of this study was to analyze the impact of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on the CT angiography source images (SI) on outcome after ET or IVT. METHODS: Using our prospectively obtained stroke database and the admission SI-ASPECTS divided into three groups (0-5, 6-7 and 8-10), primarily the rates of good outcome [modified Rankin Scale (mRS) ≤2 at discharge] after either ET (n = 255) or IVT (n = 479) were compared. RESULTS: A favorable SI-ASPECTS (8-10) was present in 501 patients, 132 patients had a moderately favorable SI-ASPECTS (6-7) and 101 patients had an unfavorable SI-ASPECTS (0-5). Irrespective of the treatment modality, no patient with an unfavorable SI-ASPECTS had a good outcome and 38% died during hospital stay. Whilst significantly more patients with a favorable SI-ASPECTS had a good outcome after ET than after IVT (51% vs. 35%, P < 0.01), there was only a non-significant trend towards a good outcome after ET than after IVT in patients with a moderately favorable ASPECTS (25% vs. 14%, P = 0.1). CONCLUSION: Patients with extensive early ischaemic changes on CT scans (SI- ASPECTS ≤5) might not profit from ET. The impact of ET on outcome in patients with moderately favorable SI-ASPECTS should be addressed in further trials.
BACKGROUND AND PURPOSE: Endovascular therapy (ET) is superior to intravenous thrombolysis (IVT) in selected patients with anterior circulation large vessel occlusions. However, it is unclear if this positive effect also applies to patients with extensive early ischaemic changes. The aim of this study was to analyze the impact of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on the CT angiography source images (SI) on outcome after ET or IVT. METHODS: Using our prospectively obtained stroke database and the admission SI-ASPECTS divided into three groups (0-5, 6-7 and 8-10), primarily the rates of good outcome [modified Rankin Scale (mRS) ≤2 at discharge] after either ET (n = 255) or IVT (n = 479) were compared. RESULTS: A favorable SI-ASPECTS (8-10) was present in 501 patients, 132 patients had a moderately favorable SI-ASPECTS (6-7) and 101 patients had an unfavorable SI-ASPECTS (0-5). Irrespective of the treatment modality, no patient with an unfavorable SI-ASPECTS had a good outcome and 38% died during hospital stay. Whilst significantly more patients with a favorable SI-ASPECTS had a good outcome after ET than after IVT (51% vs. 35%, P < 0.01), there was only a non-significant trend towards a good outcome after ET than after IVT in patients with a moderately favorable ASPECTS (25% vs. 14%, P = 0.1). CONCLUSION:Patients with extensive early ischaemic changes on CT scans (SI- ASPECTS ≤5) might not profit from ET. The impact of ET on outcome in patients with moderately favorable SI-ASPECTS should be addressed in further trials.
Authors: Andreas Kastrup; Freimuth Brunner; Helmut Hildebrandt; Christian Roth; Michael Winterhalter; Carsten Giessing; Panagiotis Papanagiotou Journal: Interv Neurol Date: 2018-07-11
Authors: Henning Muhl; Christian Roth; Andreas Schröter; Maria Politi; Maria Alexandrou; Janina Dahl; Susanne Gindorf; Panagiotis Papanagiotou; Andreas Kastrup Journal: J Clin Med Date: 2022-01-18 Impact factor: 4.241
Authors: Andreas Kastrup; Christian Roth; Maria Politi; Maria Alexandrou; Helmut Hildebrandt; Andreas Schröter; Panagiotis Papanagiotou Journal: Front Neurol Date: 2021-06-02 Impact factor: 4.003