Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Score ≤6

Desilles, Jean‐Philippe; Consoli, Arthuro; Redjem, Hocine; Coskun, Oguzhan; Cicciò, Gabriele; Smajda, Stanislas; Labreuche, Julien; Preda, Cristian; Guerrero, Clara Ruiz; Decroix, Jean‐Pierre; Rodesch, Georges; Mazighi, Mikaël; Blanc, Raphaël; Piotin, Michel; Lapergue, Bertrand

doi:10.1161/strokeaha.116.015202

Cited by 97 publications

(68 citation statements)

References 25 publications

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“…Mourand et al demonstrated good clinical outcomes in patients with DWI-ASPECTS 4–5, and suggested that younger patients (≤70 years) could be considered for EVT even with DWI-ASPECTS 0–3 31. Desilles et al described a positive although non-significant trend towards better functional outcome (23.1% vs 9.5%), lower mortality rate (45.7% vs 57.1%), and lower rate of sICH (23.9% vs 45.5%) in successfully reperfused patients compared with non-reperfused patients from the DWI-ASPECTS 0–4 subgroup 21. Nevertheless, given these patients’ overall poor prognosis, any absolute benefit with current treatment would be likely to be minimal 23.…”

Section: Discussionmentioning

confidence: 98%

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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Section: Discussionmentioning

confidence: 98%

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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“…Three of the six reviewed studies reported that successful reperfusion is associated with good prognosis [16, 18, 24]. These studies suggest that low ASPECTS should not be a contraindication for EVT treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, as some of the data were extracted from a subgroup, not a separate group in the original analysis, information regarding some of the risk factors (e.g., age, pretreatment NIHSS, reperfusion rate) that may affect prognosis is incomplete. In addition, we did not analyze hemorrhage rates, due to different study standards, as some included all hemorrhagic events [16] while others included parenchymal hematoma type 2 [24] or sICH only [18, 23, 30]. …”

Section: Discussionmentioning

confidence: 99%

“…The latest 2018 AHA/ASA guidelines for AIS recommend mechanical thrombectomy for ASPECTS ≥ 6 cases while its benefits for cases with ASPECTS < 6 were considered uncertain [12]. Many studies have confirmed that despite early successful recanalization, patients with large infarction barely benefited from EVT [13–16]. In contrast to previous studies, a recent small-sample study showed that young patients with large infarct lesions could benefit from EVT [17].…”

Section: Introductionmentioning

confidence: 99%

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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

Song

Guan

et al. 2019

Neuroradiology

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PurposeThe recommendation strength of the guidelines for mechanical thrombectomy among patients with large pre-treatment core infarct is weak. We evaluated the safety and outcome of endovascular treatment for acute ischemic stroke with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) ≤ 5.MethodsData on acute ischemic stroke patients with DWI-ASPECTS ≤ 5 who underwent endovascular treatment within 6 h, or presented an arterial spin labeling-DWI (ASL-DWI) mismatch within 12 h, at our center were retrospectively collected. We report the clinical characteristics and outcome of every patient, and review the relevant literature.ResultsAmong the 19 patients who were enrolled, all experienced successful reperfusion, and 10 achieved a favorable outcome (modified Rankin scale (mRS) ≤ 2). Two patients presented with symptomatic intracranial hemorrhage (sICH); both of them had a poor outcome (mRS > 2).ConclusionAcute ischemic stroke patients with large DWI lesions caused by large vessel occlusion can achieve a favorable clinical outcome with endovascular treatment if recanalization is performed within 6 h, or after 6 h in case of an ASL-DWI mismatch.Electronic supplementary materialThe online version of this article (10.1007/s00234-019-02177-1) contains supplementary material, which is available to authorized users.

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“…With these preliminary data and others6 that have been published, allowing a threshold of ASPECTS <6 to become entrenched may deny this emergent large vessel occlusion (ELVO) patient subgroup a valuable potential benefit. There are many theoretical concerns for thrombectomy in ASPECTS <6, including the risk of symptomatic hemorrhage, worsening cerebral edema, cost, and whether there is any valid measurable benefit.…”

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confidence: 99%

Iterating the ASPECTS <6 threshold

Mocco

Chen

2017

J NeuroIntervent Surg

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Successful Reperfusion With Mechanical Thrombectomy Is Associated With Reduced Disability and Mortality in Patients With Pretreatment Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Score ≤6

Abstract: Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5.

Cited by 97 publications

References 25 publications

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

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

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

Iterating the ASPECTS <6 threshold

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