Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 5 can benefit from endovascular treatment: a single-center experience and literature review

Song, Kangping; Guan, Min; Li, Wenxian; Jing, Zhen; Xie, Xiaomei; Shi, Changzheng; Liang, Jianye; Qiao, Hui; Huang, Lian

doi:10.1007/s00234-019-02177-1

Cited by 17 publications

(11 citation statements)

References 47 publications

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“…Overall, 1194 patients (cases) underwent MT (stent retriever, aspiration-first thrombectomy or combined techniques), whereas 184 patients (controls) were treated with medical therapy (IVT for eligible patients or conservative management). Five studies16–20 compared outcomes between the MT group and the medical treatment group whereas 12 studies21–32 reported series of patients with low ASPECTS exclusively treated with MT.…”

Section: Resultsmentioning

confidence: 99%

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Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis

Cagnazzo

Derraz

Dargazanli

et al. 2019

J NeuroIntervent Surg

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BackgroundIt is uncertain whether mechanical thrombectomy (MT) increases the probability of a good outcome (modified Rankin Scale (mRS) 0–2) in patients with Alberta Stroke Program Early CT Score (ASPECTS) 0–6.ObjectiveTo assess the impact of MT in patients with pretreatment ASPECTS 0–6.MethodsAccording to PRISMA guidelines, we performed a systematic search of three databases for series of patients with ASPECTS 0–6 treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS 0–2 at 3 months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates.ResultsWe included 17 studies and 1378 patients with ASPECTS 0–6 (1194 MT, 184 medical management). The rate of mRS 0–2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS 0–2 (OR 4.76, p=0.01). Patients with ASPECTS 6 and 5 had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS 0–2 was 17.1% in patients with ASPECTS 0–4: 22.1% and 13.9% of patients with ASPECTS 4 and 0–3 were functionally independent, respectively. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b–3) gave higher odds of mRS 0–2 than unsuccessful reperfusion (OR 5.2, p=0.001). The MT group tended to have lower odds of sICH compared with the controls (OR 0.48, p=0.06). Patients aged <70 years had higher rates of mRS 0–2 than those aged >70 years (40.3% vs 16.2%).ConclusionsPatients with ASPECTS 0–6may benefit from MT. Successful reperfusion increases the probability of 3-month functional independence without increasing the risk of sICH. Patients with ASPECTS 5 and 6 have comparable outcomes. MT can still enable approximately one in four patients with ASPECTS 4 to be independent, whereas only 14% of subjects with ASPECTS 0–3 regain a good functional outcome.

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Section: Resultsmentioning

confidence: 99%

“…Nine studies were retrospective series17–19 23 25 27–30 and eight studies had a prospective design 16 20–22 24 26 31 32. Two included series were prospective randomized trials 16 20.…”

Section: Resultsmentioning

confidence: 99%

Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis

Cagnazzo

Derraz

Dargazanli

et al. 2019

J NeuroIntervent Surg

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“…This raised the question, regarding to mechanical thrombectomy versus medical care alone in patients with large core infarct, which one is better? Although there has been some quantitative synthesis touched on this subject, they did not make a comparison with the no thrombectomy group 9,10 or had a small sample size. 11 As a consequence, the objective of this meta-analysis was to investigate that in comparison to medical treatment alone, whether thrombectomy obtained better functional outcome and safety in large ischemic core patients by both semi-quantitative (ASPECTS 0-7,0-5,5-7) and quantitative (core volume >=50 or 70 ml) imaging modalities.…”

Section: Introductionmentioning

confidence: 99%

Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis

Jiang

Wang

et al. 2021

Interv Neuroradiol

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Objective We compared outcomes and adverse events of thrombectomy versus medical management in acute ischemic stroke (AIS) patients with baseline large infarct core. Methods We searched Ovid MEDLINE(R) ALL, Cochrane Library Clinical Controlled Trials and EMBASE from inception to January 2021 for studies comparing thrombectomy and medical management alone in AIS patients who had ASPECTS <=7 or ischemic core volume >=50 ml. Imaging modalities to valuate ASPECTS and core volume were without restriction. The functional outcome was measured by mRS (modified Rankin Scale) score 0-2 at 90 days or discharge. The safety end point included the rates of mortality and sICH (symptomatic intracranial hemorrhage) or PH2 (parenchymal hematoma type 2). Results Fourteen studies with a total of 2547 patients (thrombectomy n = [1197]; medical care alone [n = 1350]) fulfilled our criteria. As for patients with low ASPECTS, pooled results indicated a higher odds of good functional outcome (OR = 3.47; 95% CI 1.99 to 6.07; P < 0.0001, I2=66%) and a lower risk of mortality (OR = 0.62; 95% CI 0.46 to 0.83; P = 0.001, I2=32%) in thrombectomy group compared with no thrombectomy group, but the risk of sICH or PH2 did not differ between two groups. As for patients with large core volume, both functional outcome and safety end point between two groups showed no statistically significant difference. Conclusion Thrombectomy remained safe and effective by careful selection in patients with low ASPECTS. More studies were warranted to explore contraindications for mechanical thrombectomy in AIS patients, especially in patients with large core volume.

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“…The incidence of AIS is high, and it progresses rapidly; accurate evaluation of the patient's condition at the early stage is critical for effective intervention in the disease progression (2). The modified early warning score (MEWS) is a physiological scoring system for early identification of critically ill patients or potentially critically ill patients, and has been widely used in clinical practice (3).…”

Section: Introductionmentioning

confidence: 99%

“…Besides, the pathogenesis of AIS is predominantly related to atherosclerosis. Atherosclerosis itself and necrotic brain tissue can activate inflammatory cells to release inflammatory mediators and aggravate tissue damage, which means the level of inflammatory factors is closely related to the condition and prognosis of AIS patients (3). Interleukin-6 (IL-6) and interleukin-8 (IL-8) are markers of the acute inflammatory response, and therapy both promoting and diminishing interleukin levels is becoming increasingly applied clinically (4).…”

Section: Introductionmentioning

confidence: 99%

Correlation between interleukin-6, interleukin-8, and modified early warning score of patients with acute ischemic stroke and their condition and prognosis

Zhang¹,

Xu²,

Zhang³

et al. 2021

Ann Palliat Med

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Background: Acute ischemic stroke (AIS) is closely related to the level of inflammatory factors. This study aimed to explore the correlation between interleukin-6 (IL-6), interleukin-8 (IL-8), and the modified early warning score (MEWS) of AIS patients and their condition and prognosis. Methods:The clinical data of 95 AIS patients admitted to our hospital from January 2019 to October 2019 were selected, and 91 cases were finally recruited to the study group according to the inclusion and exclusion criteria. A control group was recruited comprising 70 healthy patients. The differences in IL-6 and IL-8 levels between the 2 groups were compared. Multiple logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of AIS patients. A receiver-operating characteristic (ROC) curve was used to analyze the predictive value of IL-6, IL-8, and MEWS for the poor prognosis of AIS patients.Results: The levels of IL-6 and IL-8 in the study group were higher than those of the control group (P<0.05). After 90 days of treatment, 69 cases in the study group allocated into the good prognosis group, and 22 were allocated into the poor prognosis group. The National Institutes of Health Stroke Scale (NIHSS) scores before thrombolysis, blood glucose before thrombolysis, systolic blood pressure 2 h after thrombolysis, IL-6, IL-8, and MEWS scores within 24 h of admission in the good prognosis group were lower than those of the poor prognosis group (P<0.05). The area under the curve (AUC) of IL-6, IL-8, MEWS, and the 3 combined curves were 0.937, 0.897, 0.839, and 0.976, respectively, and the area under the combined detection curve was the largest. Conclusions:The inflammatory response and secondary brain damage after AIS are influenced by IL-6 and IL-8. Combined with the MEWS score, IL-6 and IL-8 can be used as important indicators to judge the severity of the early condition of AIS patients. The combination of these 3 indicators has high accuracy in evaluating the prognosis of patients and is worthy of clinical promotion.

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Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 5 can benefit from endovascular treatment: a single-center experience and literature review

Cited by 17 publications

References 47 publications

Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis

Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis

Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis

Correlation between interleukin-6, interleukin-8, and modified early warning score of patients with acute ischemic stroke and their condition and prognosis

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