Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry

Abstract

Background and Purpose: This study investigates clinical outcomes after mechanical thrombectomy in adult patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) of 0 to 5. Methods: We included data from the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) from patients who underwent mechanical thrombectomy within 8 hours of symptom onset and had available ASPECTS data adjudicated by an independent core laboratory. Angiographic and clinical outcomes were collected, including successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), functional independence (modified Rankin Scale score 0–2), 90-day mortality, and symptomatic intracranial hemorrhage at 24 hours. Outcomes were stratified by ASPECTS scores and age. Results: Of the 984 patients enrolled, 763 had available ASPECTS data. Of these patients, 57 had ASPECTS of 0 to 5 with a median age of 63 years (interquartile range, 28–100), whereas 706 patients had ASPECTS of 6 to 10 with a median age of 70 years of age (interquartile range, 19–100). Ten patients had ASPECTS of 0 to 3 and 47 patients had ASPECTS of 4 to 5 at baseline. Successful reperfusion was achieved in 85.5% (47/55) in the ASPECTS of 0 to 5 group. Functional independence was achieved in 28.8% (15/52) in the ASPECTS of 0 to 5 versus 59.7% (388/650) in the 6 to 10 group ( P <0.001). Mortality rates were 30.8% (16/52) in the ASPECTS of 0 to 5 and 13.4% (87/650) in the 6 to 10 group ( P <0.001). sICH rates were 7.0% (4/57) in the ASPECTS of 0 to 5 and 0.9% (6/682) in the 6 to 10 group ( P <0.001). No patients aged >75 years with ASPECTS of 0 to 5 (0/12) achieved functional independence versus 44.8% (13/29) of those age ≤65 ( P =0.005). Conclusions: Patients <65 years of age with large core infarction (ASPECTS 0–5) have better rates of functional independence and lower rates of mortality compared with patients >75 years of age. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02239640.

Prediction of 90 day home time among patients with low baseline ASPECTS undergoing endovascular thrombectomy: results from Alberta’s Provincial Stroke Registry (QuICR)

“…Our study did not show a significant difference in rates of 90 day mortality and sICH between low versus higher ASPECTS groups. This is similar to the results from the MR CLEAN trial25 but different from the HERMES analysis and STRATIS registry data 3 22. This is a conflicting yet reassuring finding from this study on the safety outcomes in low ASPECTS patients treated with EVT.…”

“…However, there are conflicting data on these topics in the literature 4 19 20. For example, data from the HERMES meta-analysis showed that patients with ASPECTS 3–5 benefited from EVT, while other non-randomized studies showed discrepant findings, leading to more uncertainties in the field 5 7 21–23. Recently, RESCUE JAPAN LIMIT randomized 203 patients with ASPECTS 3–5 onset into EVT with medical therapy versus medical therapy alone.…”

Are We Ready to Offer Endovascular Thrombectomy to All Patients With Large Ischemic Core?

“…The Systematic Evaluation of Patients Treated with Neurothrombectomy Devices for Acute Ischemic Stroke (STRATIS) registry looked at the impact of age in 57 patients with CT-ASPECTS 0–5 who underwent thrombectomy. Successful reperfusion (≥TICI 2b) was achieved in 85.5% (47/55) in the ASPECTS of 0 to 5 group; however, functional independence was only achieved in 28.8% (15/52), with no patients >75 years of age achieving good outcomes ( 13 ). This implies that a more precise method of patient and imaging selection is required in patients with expected large core infarcts.…”

“…Similar findings were seen in DEFUSE-3 for functional independence at 90 days, significantly favoring the endovascular arm compared to medical therapy with a risk ratio of 2.67 (95% CI, 1.6–4.48). The risk ratio for the subgroup of ischemic core volume of 10–25 ml was 4.4 (95% CI, 1.41–20.33) and ischemic core volume 25–70 ml was 3.06 (95% CI, 1.01–13.52) ( 13 ). These two landmark trials indicate that a selected group of patients with a core volume of <70 ml is favorable with EVT.…”

Impact of Body Temperature in Patients With Acute Basilar Artery Occlusion: Analysis of the BASILAR Database

“…For large vessel occlusive strokes, reperfusion therapy is the best treatment modality. Therefore, many clinical trials have focused on symptomatology, imaging, and temporal interventions to improve the clinical prognosis of patients and guide treatment choice (2)(3)(4). Recently, few studies have focused on the prognostic impact of vital signs in patients with ischemic stroke.…”