Caitriona Logan1, Julian Maingard2, Kevin Phan3, Ronan Motyer1, Christen Barras4, Seamus Looby1, Paul Brennan1, Alan O'Hare1, Duncan Mark Brooks5, Ronil V Chandra6, Hamed Asadi7, Hong Kuan Kok1, John Thornton1. 1. Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland. 2. Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Electronic address: Julian.maingard@gmail.com. 3. NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia. 4. Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia. 5. Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia. 6. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; Department of Imaging, Monash University, Melbourne, Australia. 7. Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; Department of Imaging, Monash University, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Electronic address: asadi.hamed@gmail.com.
Abstract
OBJECTIVE: Selection of patients with acute ischemic stroke for endovascular thrombectomy (EVT) is complex and time-critical. Benefits of EVT are well established for patients with small core infarcts. The aim of this study was to compare clinical outcomes of EVT in patients with larger established infarcts (Alberta Stroke Programme Early CT Score [ASPECTS] ≤6) with patients with smaller infarcts (ASPECTS 7-10). METHODS: The study included 355 patients with acute ischemic stroke due to large vessel occlusion who underwent EVT. ASPECTS was assigned to baseline noncontrast computed tomography, and collateral perfusion scores were assigned to multiphase computed tomography angiography. Baseline stroke severity, collateral grading, and clinical outcome data (complication rate, symptomatic intracranial hemorrhage and 90-day modified Rankin Scale score) were compared between patients with borderline (≤6) and high (7-10) ASPECTS. RESULTS: There were 34 (10%) patients with borderline ASPECTS. There was no difference in rate of good clinical outcome (37% vs. 46%, P = 0.852), symptomatic intracerebral hemorrhage (9% vs. 9%, P = 0.984), or mortality (20% vs. 22%, P = 0.818) between patients with borderline ASPECTS and high ASPECTS at 90 days. Moreover, there was no significant difference in collateral perfusion grade. CONCLUSIONS: This study identifies similar clinical benefit of EVT in patients with acute large vessel occlusion stroke with borderline ASPECTS and high ASPECTS.
OBJECTIVE: Selection of patients with acute ischemic stroke for endovascular thrombectomy (EVT) is complex and time-critical. Benefits of EVT are well established for patients with small core infarcts. The aim of this study was to compare clinical outcomes of EVT in patients with larger established infarcts (Alberta Stroke Programme Early CT Score [ASPECTS] ≤6) with patients with smaller infarcts (ASPECTS 7-10). METHODS: The study included 355 patients with acute ischemic stroke due to large vessel occlusion who underwent EVT. ASPECTS was assigned to baseline noncontrast computed tomography, and collateral perfusion scores were assigned to multiphase computed tomography angiography. Baseline stroke severity, collateral grading, and clinical outcome data (complication rate, symptomatic intracranial hemorrhage and 90-day modified Rankin Scale score) were compared between patients with borderline (≤6) and high (7-10) ASPECTS. RESULTS: There were 34 (10%) patients with borderline ASPECTS. There was no difference in rate of good clinical outcome (37% vs. 46%, P = 0.852), symptomatic intracerebral hemorrhage (9% vs. 9%, P = 0.984), or mortality (20% vs. 22%, P = 0.818) between patients with borderline ASPECTS and high ASPECTS at 90 days. Moreover, there was no significant difference in collateral perfusion grade. CONCLUSIONS: This study identifies similar clinical benefit of EVT in patients with acute large vessel occlusion stroke with borderline ASPECTS and high ASPECTS.
Authors: James E Siegler; Steven R Messé; Heidi Sucharew; Scott E Kasner; Tapan Mehta; Niraj Arora; Amy K Starosciak; Felipe De Los Rios La Rosa; Natasha R Barnhill; Akshitkumar M Mistry; Kishan Patel; Salman Assad; Amjad Tarboosh; Katarina Dakay; Sanjana Salwi; Jeff Wagner; Alicia Bennett; Bharathi D Jagadeesan; Christopher Streib; Stewart A Weber; Rohan Chitale; John J Volpi; Stephan A Mayer; Shadi Yaghi; Mahesh Jayaraman; Pooja Khatri; Eva A Mistry Journal: Neurosurgery Date: 2020-02-01 Impact factor: 4.654