Outcomes Are Not Different between Patients with Intermediate and High DWI-ASPECTS after Stent-Retriever Embolectomy for Acute Anterior Circulation Stroke

Kim, Seul-Kee; Yoon, Woong; Park, Man‐Seok; Heo, Tag; Baek, Byung Hyun; Lee, Yun Young

doi:10.3174/ajnr.a4663

Cited by 20 publications

(20 citation statements)

References 31 publications

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“…Most of the identified predictors were similar to those found in previous studies, i.e., advanced age, NIHSS at presentation, and successful revascularization [9, 11]. Previous studies already demonstrate the importance of revascularization and highlight aiming for swift and complete revascularization when performing IAT [9-11, 24, 33]. In contrast to previous studies [2, 3], ours did not show a significant influence of time from symptom onset to the end of IAT.…”

Section: Discussionsupporting

confidence: 72%

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Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

et al. 2018

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Background: Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. Objective: The aim of this work was to assess the association between successful reperfusion and clinical outcome. Methods: Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry. The association with functional outcome using the modified Rankin Scale (mRS) after 3 months was assessed using multivariable logistic regression. An extension of the modified TICI score, eTICI, was used to classify reperfusion status. The prognostic value of reperfusion status after IAT in addition to age, stroke severity, imaging characteristics, treatment with intravenous thrombolysis, and time from symptom onset to the end of IAT was assessed with logistic regression and summarized with receiver operating characteristic curves. Results: In total, 119 patients were included (mean age 66 years). In multivariable analysis, age >80 years (OR 6.8, 95% CI 1.2–39.8), NIHSS at presentation >15 (OR 7.3, 95% CI 2.3–23.5), and incomplete reperfusion status (eTICI score <2C; OR 10.3, 95% CI 3.5–30.6) were the strongest predictors of a poor outcome (mRS 3–6). Adding reperfusion status to the model improved the prognostic accuracy (AUC 0.88, 95% CI 0.91–0.94). Our results indicate a large difference between using an eTICI cutoff of ≥2C versus ≥2B: a cutoff ≥2C improved the predictive value for a good clinical outcome (2C: positive predictive value, PPV, 0.78; 2B: PPV 0.32). Conclusion: Our results promote using reperfusion status for assessing prognosis in ischemic stroke patients treated with IAT. A model using eTICI ≥2C had greater PPV than eTICI ≥2B and could improve prognostic accuracy.

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Section: Discussionsupporting

confidence: 72%

“…CT ASPECTS has limited inter- and intrarater reliability [39] and is less predictive than diffusion-weighted imaging (DWI)-ASPECTS or CT perfusion [40-42]. However, recent studies using MRI DWI-ASPECTS also highlighted the importance of reperfusion status for the prediction of outcome [33, 43]. …”

Section: Discussionmentioning

confidence: 99%

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

et al. 2018

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“…Of these, 13 studies were pertinent to include in this review [34511121318192021222324]. A flow diagram summarizing the literature search is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Alberta Stroke Program Early CT Score in the Prognostication after Endovascular Treatment for Ischemic Stroke: A Meta-analysis

et al. 2017

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PurposeThe Alberta Stroke Program Early CT Score (ASPECTS) was devised to quantify the extent of early ischemic changes in the middle cerebral artery territory on brain CT. We performed a systematic review and meta-analysis of studies that presented clinical outcomes and baseline ASPECTS in ischemic stroke patients managed with endovascular methods to validate the use of ASPECTS for risk prognostication.Materials and MethodsWe searched the MEDLINE, EMBASE, and Cochran databases for observational or interventional studies that reported clinical outcomes and baseline ASPECTS in ischemic stroke patients treated with endovascular methods. Data were pooled to perform a meta-analysis for comparisons of clinical outcomes between high and low ASPECTS patients.ResultsA meta-analysis of 13 studies (six observational and seven interventional) revealed favorable outcomes (mRS sore 0-2 at 90 days) for high baseline ASPECTS (odds ratio=2.22; 95% CI: 1.74-2.86).ConclusionHigh ASPECTS is a predictor of favorable outcome after endovascular therapy for ischemic stroke.

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“…However, due to the strict exclusion criteria employed in all but one of these trials, patients with ASPECTS ≤6 were under-represented in the data. Subsequent studies by Kim et al ,22 Logan et al 15 and Hungerford et al ,20 all retrospective reviews of prospectively-maintained databases in which patients with ASPECTS ≤6 were included, also demonstrated similar or equivalent functional outcomes after EVT for patients with unfavorable baseline ASPECTS. Limitations of study design may have affected these results as well.…”

Section: Discussionmentioning

confidence: 95%

Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis

Phan¹,

Saleh²,

Dmytriw

et al. 2018

J NeuroIntervent Surg

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BackgroundPrompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inconsistent in patient risk stratification and selection.ObjectiveTo conduct a meta-analysis to evaluate the available evidence for a clinically valid ASPECTS threshold in assessment of suitability for revascularization following AIS.MethodsTwo independent reviewers searched Medline (Ovid) and Cochrane Central Register of Systematic Reviews databases for studies appraising outcomes of endovascular thrombectomy (EVT) in relation to a variably-defined preoperative ASPECTS.ResultsA total of 13 articles were included. The pooled good outcome proportion after EVT was 41.4% (95% CI 36.4% to 46.6%; p<0.001), with subjective study-specific definitions of favorable and unfavorable subgroup outcomes of 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) and 33.2% (95% CI 28.5% to 38.3%; I2=33.16%), respectively. Objective trichotomization into low (0–4), intermediate (5–7), and high (8–10) subgroups yielded pooled good outcome proportions of 17.1% (95% CI 6.8% to 36.8%; I2=64.24%; p=0.039), 35.7% (95% CI 30.5% to 41.3%; I2=23.11%; p=0.245), and 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) for low, intermediate, and high ASPECTS, respectively.ConclusionsA subjectively favorable ASPECTS is associated with significantly better outcomes after EVT than an unfavorable ASPECTS, regardless of the cut-off used. EVT is unlikely to be useful in patients with an objectively low ASPECTS and is likely to be useful for those with high ASPECTS; findings in patients with intermediate ASPECTS were equivocal.

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Outcomes Are Not Different between Patients with Intermediate and High DWI-ASPECTS after Stent-Retriever Embolectomy for Acute Anterior Circulation Stroke

Cited by 20 publications

References 31 publications

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

Alberta Stroke Program Early CT Score in the Prognostication after Endovascular Treatment for Ischemic Stroke: A Meta-analysis

Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis

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