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

Détails

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Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_DC46B6EA4905
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study.
Périodique
International journal of stroke
Auteur⸱e⸱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
Statut éditorial
Publié
Date de publication
04/2022
Peer-reviewed
Oui
Volume
17
Numéro
4
Pages
434-443
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
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.
Mots-clé
Aged, Aged, 80 and over, Brain Ischemia/diagnostic imaging, Brain Ischemia/surgery, Cohort Studies, Endovascular Procedures/methods, Humans, Ischemic Stroke, Middle Aged, Retrospective Studies, Stroke/surgery, Thrombectomy/methods, Tomography, X-Ray Computed/methods, Treatment Outcome, ASPECTS, Acute ischemic stroke, endovascular treatment, late time window
Pubmed
Web of science
Open Access
Oui
Création de la notice
02/04/2021 13:19
Dernière modification de la notice
20/04/2024 7:17
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