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

Cagnazzo, Fédérico; Derraz, Imad; Dargazanli, Cyril; Lefevre, Pierre-Henri; Gascou, Grégory; Riquelme, Carlos; Bonafé, Alain; Costalat, Vincent

doi:10.1136/neurintsurg-2019-015237

Cited by 86 publications

(61 citation statements)

References 37 publications

(88 reference statements)

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“…This may be related to the nursing care of postoperative patients in our hospital and could be improved in the future. Numerous studies have confirmed that age is significantly associated with the prognosis of acute stroke patients (12,21,22). This current study further confirmed the important role of age in the unsatisfactory outcomes and in-hospital mortality.…”

Section: Discussionsupporting

confidence: 87%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: The mortality of acute ischemic stroke patients caused by vertebrobasilar artery occlusion (VBAO) is high and mechanical thrombectomy has gradually become a promising treatment for acute ischemic stroke. This study analyzed the efficacy of mechanical thrombectomy and the risk factors associated with poor outcomes in VBAO patients caused by severe local atherosclerotic stenosis.Methods: This retrospective study enrolled patients with acute ischemic stroke caused by VBAO between March 1, 2016 and August 31, 2019. Patient demographic and clinical data were collected retrospectively. All enrolled patients were retrospectively interviewed for at least 3 months. Patients with a modified Rankin scale (mRS) score between 0 and 3 points were defined as having satisfactory outcomes while those with more than 3 points were defined as having unsatisfactory outcomes. In-hospital mortality, the rates of recanalization, and the rates of intracerebral hemorrhage were also recorded. Multivariable logistic regression was used to determine the risk factors of unsatisfactory outcomes in enrolled patients.Results: A total of 65 patients were enrolled in this study with a median age 69.0 (63.0-78.0) years and 48 patients (73.8%) were male. Approximately 50% of patients had a mRS score of 0 or 1 point within 90 days after treatment with mechanical thrombectomy and 14 patients had a mRS score of 6 points. A total of 11 patients died in hospital. Out of the 65 patients, 7 required recanalization and 9 patients suffered from intracerebral hemorrhage. Multivariate logistic regression analysis showed that older age, lower baseline posterior circulation acute stroke prognosis early CT score (pcASPECTS), higher baseline National Institutes of Health stroke scale (NIHSS) score, and residual stenosis were independent risk factors of both unsatisfactory outcomes and mortality of VBAO patients.Conclusions: This study confirmed the important role of mechanical thrombectomy in the treatment of acute ischemic stroke caused by VBAO and may provide some guidance for improving the prognosis of patients.

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Section: Discussionsupporting

confidence: 87%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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“… 22 Another meta-analysis of 17 studies reported mRS score of 0 to 2 for 1378 patients with ASPECTS of 0 to 6; mRS score of 0 to 2 rate was 37.7% for ASPECTS of 6, 33.3% for ASPECTS of 5, 22.1% for ASPECTS of 4, 17.1% for ASPECTS of 0 to 4, and 13.9% for ASPECTS of 0 to 3 groups. 23 These findings, in combination with the present study, suggest patients with low baseline ASPECTS tend to have worse outcomes after MT. A subgroup analysis of a large multicenter retrospective registry (the Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices using the SOLITAIRE FR With the Intention For Thrombectomy [BEYOND-SWIFT]) reported an overall mRS score of 0 to 2 in 24.6% patients with ASPECTS of 0 to 5 at 90 days, with a higher likelihood of favorable outcome (mRS score 0–3) in reperfused patients (Thrombolysis in Cerebral Infarction 2b–3) than nonreperfused (35.2% versus 8.3%, P =0.014), and comparable to those with ASPECTS of 6 to 10 ( P =0.441).…”

Section: Discussionsupporting

confidence: 79%

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

Zaidat

Liebeskind

Jadhav

et al. 2021

Stroke

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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.

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“…The authors found that even in ASPECTS 4 patients, one in four would be independent, whereas only 14% of patients with ASPECTS 0-3 regained a good functional outcome. 19 In conclusion, there is to date insufficient high-quality evidence to suggest that EVT is both safe and effective in patients with low ASPECTS scores. This was also acknowledged by experts of the European Stroke Organisation, the European Society for Minimally Invasive Neurological Therapy (ESMINT), and the European Society of Neuroradiology in a consensus statement on thrombectomy, 20 leading to the initiation of several randomized controlled trials such as TENSION 21 and RESCUE-Japan LIMIT (ClinicalTrials.gov: NCT03702413).…”

Section: Extent Of Infarctionmentioning

confidence: 92%

Expanding indications for endovascular thrombectomy-how to leave no patient behind

Sporns

Fiehler

Ospel

et al. 2021

Ther Adv Neurol Disord

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Endovascular thrombectomy (EVT) has become standard of care for large vessel occlusion strokes but current guidelines exclude a large proportion of patients from this highly effective treatment. This review therefore focuses on expanding indications for EVT in several borderline indications such as patients in the extended time window, patients with extensive signs of infarction on admission imaging, elderly patients and patients with pre-existing deficits. It also discusses the current knowledge on intravenous thrombolysis as an adjunct to EVT and EVT as primary therapy for distal vessel occlusions, for tandem occlusions, for basilar artery occlusions and in pediatric patients. We provide clear recommendations based on current guidelines and further literature.

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

Cited by 86 publications

References 37 publications

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

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

Expanding indications for endovascular thrombectomy-how to leave no patient behind

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