Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5.

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Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_7D7416852B6A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5.
Journal
Stroke
Author(s)
Kaesmacher J., Chaloulos-Iakovidis P., Panos L., Mordasini P., Michel P., Hajdu S.D., Ribo M., Requena M., Maegerlein C., Friedrich B., Costalat V., Benali A., Pierot L., Gawlitza M., Schaafsma J., Mendes Pereira V., Gralla J., Fischer U.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
04/2019
Peer-reviewed
Oui
Volume
50
Number
4
Pages
880-888
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Background and Purpose- If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0-5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0-5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods- Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration-URL: https://www.clinicaltrials.gov . Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0-3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0-2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results- Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0-5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363-12.961), functional independence (aOR, 5.583; 95% CI, 1.964-15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083-0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062-0.887). The mortality-reducing effect remained in patients with ASPECTS 0-4 (aOR, 0.167; 95% CI, 0.056-0.499). Sensitivity analyses did not change the primary results. Conclusions- In patients presenting with ASPECTS 0-5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
Keywords
Aged, Aged, 80 and over, Brain Ischemia/diagnostic imaging, Brain Ischemia/surgery, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Registries, Stroke/diagnostic imaging, Stroke/surgery, Thrombectomy/methods, Tomography, X-Ray Computed, Treatment Outcome, infarction, magnetic resonance imaging, reperfusion, selection for treatment, thrombectomy, tomography
Pubmed
Web of science
Open Access
Yes
Create date
07/04/2019 14:19
Last modification date
11/01/2020 6:16
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