ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study.

Details

Serval ID
serval:BIB_DC46B6EA4905
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study.
Journal
International journal of stroke
Author(s)
Nannoni S., Kaesmacher J., Ricciardi F., Strambo D., Dunet V., Hajdu S., Saliou G., Mordasini P., Hakim A., Arnold M., Gralla J., Fischer U., Michel P.
ISSN
1747-4949 (Electronic)
ISSN-L
1747-4930
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
The DAWN trial demonstrated the effectiveness of late endovascular treatment in acute ischemic stroke patients selected on the basis of a clinical-core mismatch. We explored in a real-world sample of endovascular treatment patients if a clinical-ASPECTS (Alberta Stroke Program Early CT Score) mismatch was associated with an outcome benefit after late endovascular treatment.
We retrospectively analyzed all consecutive acute ischemic stroke patients admitted 6-24 h after last proof of good health in two stroke centers, with initial National Institutes of Health Stroke Scale (NIHSS) ≥10 and an internal carotid artery or M1 occlusion. We defined clinical-ASPECTS mismatch as NIHSS ≥ 10 and ASPECTS ≥ 7, or NIHSS ≥ 20 and ASPECTS ≥ 5. We assessed the interaction between the presence of the clinical-ASPECTS mismatch and late endovascular treatment using ordinal shift analysis of the three-month modified Rankin Scale and adjusting for multiple confounders.
The included 337 patients had a median age of 73 years (IQR = 61-82), admission NIHSS of 18 (15-22), and baseline ASPECTS of 7 (5-9). Out of 196 (58.2%) patients showing clinical-ASPECTS mismatch, 146 (74.5%) underwent late endovascular treatment. Among 141 (41.8%) mismatch negative patients, late endovascular treatment was performed in 72 (51.1%) patients. In the adjusted analysis, late endovascular treatment was significantly associated with a better outcome in the presence of clinical-ASPECTS mismatch (adjusted odd ratio, aOR = 2.83; 95% confidence interval, CI: 1.48-5.58) but not in its absence (aOR = 1.32; 95%CI: 0.61-2.84). The p-value for the interaction term between clinical-ASPECTS mismatch and late endovascular treatment was 0.073.
In our retrospective two-site analysis, late endovascular treatment seemed effective in the presence of a clinical-ASPECTS mismatch, but not in its absence. If confirmed in randomized trials, this finding could support the use of an ASPECTS-based selection for late endovascular treatment decisions, obviating the need for advanced imaging.
Keywords
ASPECTS, Acute stroke therapy, CT scan, Endovascular treatment, Ischaemic stroke, Late time window, Acute ischemic stroke, endovascular treatment, late time window
Pubmed
Web of science
Open Access
Yes
Create date
02/04/2021 13:19
Last modification date
20/06/2021 17:30
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