Regional Contributions to Poststroke Disability in Endovascular Therapy.

Sheth, Sunil A; Malhotra, Konark; Liebeskind, David S; Liang, Conrad W; Yoo, Albert J; Jahan, Reza; Nogueira, Raul G; Pereira, Vitor; Gralla, Jan; Albers, Greg; Goyal, Mayank; Saver, Jeffrey L (2018). Regional Contributions to Poststroke Disability in Endovascular Therapy. Interventional neurology, 7(6), pp. 533-543. Karger 10.1159/000492400

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Background and Purpose The relative contribution of each Alberta Stroke Program Early CT Score (ASPECTS) region to poststroke disability likely varies across regions. Determining the relative weights of each ASPECTS region may improve patient selection for endovascular stroke therapy (EST). Methods In the combined Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT), Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and Solitaire Flow Restoration with the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) databases, we identified patients treated with the Solitaire stent retriever. Using 24-h CT scan, a multivariate ordinal regression was used to determine the relative contribution of each ASPECTS region to clinical outcome separately in each hemisphere. The coefficients from the regression were used to create a weighted ASPECTS (wASPECTS), which was compared with the original ASPECTS to predict 90-day modified Rankin Scale disability outcomes in an independent validation cohort. Results Among 342 patients treated with EST, the average age was 67 years, 57% were female, and the median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13-20). The median ASPECTS at presentation was 8 (IQR 7-10). The most commonly involved ASPECTS regions on 24-h CT were the lentiform nuclei (70%), insula (55%), and caudate (52%). In multivariate analysis, preservation of M6 (β = 9.7) and M4 (β = 4.4) regions in the right hemisphere was most strongly predictive of good outcome. For the left hemisphere, M6 (β = 5.5), M5 (β = 4.1), and M3 (β = 3.1) generated the greatest parameter estimates, though they did not reach statistical significance. A wASPECTS incorporating all 20 parameter estimates resulted in improved discrimination against the original ASPECTS in the independent cohort (C-statistic 0.78 vs. 0.67, right hemisphere). Conclusions For both right and left hemisphere, preservation of the high cortical regions was more strongly associated with improved outcomes compared to the deep regions. Our findings support taking into consideration the location and relative weightings of the involved ASPECTS regions when evaluating a patient for EST.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Gralla, Jan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1664-9737

Publisher:

Karger

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

14 Nov 2018 09:02

Last Modified:

14 Nov 2018 09:02

Publisher DOI:

10.1159/000492400

PubMed ID:

30410533

Uncontrolled Keywords:

ASPECTS Eloquence Large vessel occlusion Neuroimaging Stroke

URI:

https://boris.unibe.ch/id/eprint/121134

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