O-006 The impact of endovascular therapy on patients with large cerebral infarction; subanalysis of rescue-japan registry 2

Kakita, Hiroto; Yoshimura, Shinichi; Uchida, Keiji; Sakai, Nobuyuki; Yamagami, Hiroshi; Morimoto, Takeshi

doi:10.1136/neurintsurg-2018-snis.6

Cited by 4 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The aim of the present study was to compare outcomes in patients aged ≥90 years with acute LVO stroke between EVT and medical management, using the data from a nationwide, prospective registry study, the RESCUE-Japan Registry 2 (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism). [9][10][11]…”

Section: Clinical and Population Sciencesmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years

Fujita

Tanaka

Yamagami

et al. 2021

Stroke

View full text Add to dashboard Cite

Background and Purpose: Outcomes in patients ≥90 years of age with stroke due to large vessel occlusion were compared between endovascular therapy (EVT) and medical management. Methods: Of 2420 acute ischemic stroke patients with large vessel occlusion in a prospective, multicenter, nationwide registry in Japan, patients aged ≥90 years with occlusion of the internal carotid artery or M1 segment of the middle cerebral artery were included. The primary effectiveness outcome was a favorable outcome at 3 months, defined as achieving a modified Rankin Scale score of 0 to 2 or return to at least the prestroke modified Rankin Scale score at 3 months. Safety outcomes included symptomatic intracranial hemorrhage within 72 hours after onset. Intergroup biases were adjusted by multivariable adjustment with inverse probability of treatment weighting. Results: A total of 150 patients (median age, 92 [interquartile range, 90–94] years; median prestroke modified Rankin Scale score, 2 [interquartile range, 0–4]) were analyzed. EVT was performed in 49 patients (32.7%; mechanical thrombectomy, n=43). The EVT group showed shorter time from onset to hospital arrival ( P =0.03), higher Alberta Stroke Program Early Computed Tomography Score ( P <0.01), and a higher rate of treatment with intravenous thrombolysis ( P <0.01) than the medical management group. The favorable outcome was seen in 28.6% of the EVT group and 6.9% of the medical management group ( P <0.01). EVT was associated with the favorable outcome (adjusted odds ratio, 8.44 [95% CI, 1.88–37.97]). Rates of symptomatic intracranial hemorrhage were similar between the EVT group (0.0%) and the medical management group (3.9%; P =0.30). Conclusions: Patients who underwent EVT showed better functional outcomes than those with medical management without increased symptomatic intracranial hemorrhages. Given proper patient selection, withholding EVT solely on the basis of the age of patients may not offer the best chance of good outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02419794.

show abstract

Section: Clinical and Population Sciencesmentioning

confidence: 99%

“…The design and data have been published elsewhere. [9][10][11] All study procedures were reviewed and approved by the ethics committees of the participating institutions. Written informed consent from each patient was waived in this study because clinical information obtained in routine clinical practice was used.…”

Section: Study Populationmentioning

confidence: 99%

Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years

Fujita

Tanaka

Yamagami

et al. 2021

Stroke

View full text Add to dashboard Cite

show abstract

“…Because LVO‐related AIS patients with large core are expected to have high rates of poor functional outcomes regardless of treatment, 3,4 they were largely excluded from the pivotal MT trials, and current guidelines do not recommend MT in this population 1,2 . Nonetheless, subgroup analysis of the MT trials has suggested that MT may improve functional outcome –as compared to BMM alone– in this population, 4 consistent with several observational studies 5–10 . However, uncertainty remains about which patients with large core may benefit from MT.…”

mentioning

confidence: 86%

“…1,2 Nonetheless, subgroup analysis of the MT trials has suggested that MT may improve functional outcome -as compared to BMM alone-in this population, 4 consistent with several observational studies. [5][6][7][8][9][10] However, uncertainty remains about which patients with large core may benefit from MT.…”

mentioning

confidence: 99%

Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core

Seners

Oppenheim

Turc

et al. 2021

Annals of Neurology

View full text Add to dashboard Cite

Objective Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue (“core”). Perfusion imaging may identify a subset of patients with large core who benefit from MT. Methods We compared two cohorts of LVO‐related patients with large core (>50 ml on diffusion‐weighted‐imaging or CT‐perfusion using RAPID), available perfusion imaging, and treated within 6 hours from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre‐MT era from a prospective registry. Primary outcome was 90‐day modified Rankin Scale ≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio = critical hypoperfusion/core volume). Results Overall, 107 patients were included (56 MT + BMM and 51 BMM): Mean age was 68 ± 15 years, median core volume 99 ml (IQR: 72–131) and MMRatio 1.4 (IQR: 1.0–1.9). Baseline clinical and radiological variables were similar between the two groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (pinteraction < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95% CI] = 6.8 [1.7–27.0] vs 0.7 [0.1–6.2], respectively). Similar findings were present for MMRatio ≥1.8 in the subgroup with core ≥70 ml. Parenchymal hemorrhage on follow‐up imaging was more frequent in the MT + BMM group regardless of the MMRatio. Interpretation Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021;90:417–427

show abstract

“…8 Notwithstanding the latter, this effect seems not to be valid for CT-based patient selection (Figure I in the Data Supplement), 9,10 although, CT imaging represents the most frequently applied realworld modality for detection and treatment of large vessel occlusion stroke. 11 Hence, currently available randomized as well as retrospective evidence (Table 1) [12][13][14][15][16][17][18][19][20] might not be representative for a real-world setting with CT-based decision-making for EVT in patients with low ASPECTS. 9 Furthermore, it remains unclear if the overall treatment effect in patients with low ASPECTS will outweigh procedure-related risks in cases where EVT is unsuccessful.…”

Section: See Related Article P 3118mentioning

confidence: 99%

Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage

Meyer

Bechstein

Bester

et al. 2021

Stroke

View full text Add to dashboard Cite

Background and Purpose: This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment. Methods: This retrospective, multicenter study compares EVT and best medical treatment for computed tomography (CT)–based selection of patients with extensive baseline infarcts (Alberta Stroke Program Early CT Score ≤5) attributed to anterior circulation stroke. Patients were selected from the German Stroke Registry and 3 tertiary stroke centers. Primary functional end points were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Secondary safety end point was the occurrence of symptomatic intracerebral hemorrhage. Angiographic outcome was evaluated with the modified Thrombolysis in Cerebral Infarction Scale. Results: After 1:1 pair matching, a total of 248 patients were compared by treatment arm. Good functional outcome was observed in 27.4% in the EVT group, and in 25% in the best medical treatment group ( P =0.665). Advanced age (adjusted odds ratio, 1.08 [95% CI, 1.05–1.10], P <0.001) and symptomatic intracerebral hemorrhage (adjusted odds ratio, 6.35 [95% CI, 2.08–19.35], P <0.001) were independently associated with very poor outcome. Mortality (43.5% versus 28.9%, P =0.025) and symptomatic intracerebral hemorrhage (16.1% versus 5.6%, P =0.008) were significantly higher in the EVT group. The lowest rates of good functional outcome (≈15%) were observed in groups of failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a), whereas patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most (modified Rankin Scale score of ≤3:42.3%, P =0.074) compared with best medical treatment. Conclusions: In daily clinical practice, EVT for CT–based selected patients with low Alberta Stroke Program Early CT Score anterior circulation stroke may not be beneficial and is associated with increased risk for hemorrhage and mortality, especially in the elderly. However, first- or second-pass complete recanalization seems to reveal a clinical benefit of EVT highlighting the vulnerability of the low Alberta Stroke Program Early CT Score subgroup. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03356392.

show abstract

O-006 The impact of endovascular therapy on patients with large cerebral infarction; subanalysis of rescue-japan registry 2

Cited by 4 publications

References 0 publications

Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years

Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years

Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core

Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage

Contact Info

Product

Resources

About