ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study.

Nannoni, Stefania; Kaesmacher, Johannes; Ricciardi, Federico; Strambo, Davide; Dunet, Vincent; Hajdu, Steven; Saliou, Guillaume; Mordasini, Pasquale; Hakim, Arsany; Arnold, Marcel; Gralla, Jan; Fischer, Urs; Michel, Patrik (2021). ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study. (In Press). International journal of stroke, p. 17474930211009806. SAGE 10.1177/17474930211009806

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IntroductionThe DAWN trial demonstrated the effectiveness of late endovascular treatment (EVT) in acute ischemic stroke (AIS) patients selected on the basis of a clinical-core mismatch. We explored in a real-world sample of EVT patients if a clinical-ASPECTS (Alberta Stroke Program Early CT Score) mismatch was associated with an outcome benefit after late EVT. MethodsWe retrospectively analysed all consecutive AIS patients admitted 6-24 hours after last proof of good health in two stroke centres, with initial National Institutes of Health Stroke Scale (NIHSS) â¥10 and an internal carotid artery or M1 occlusion. We defined clinical-ASPECTS mismatch as NIHSSâ¥10 and ASPECTSâ¥7, or NIHSSâ¥20 and ASPECTSâ¥5. We assessed the interaction between clinical-ASPECTS mismatch positive and negative patients and late EVT, using ordinal shift analysis of the 3-month modified Rankin Scale and adjusting for multiple confounders.ResultsThe included 337 patients had a median age of 73 years (IQR=61-82), admission NIHSS of 18 (15-22) and baseline ASPECTS of 7 (5-9). Out of 196 (58.2%) patients showing clinical-ASPECTS mismatch, 146 (74.5%) underwent late EVT. Among 141 (41.8%) mismatch negative patients, late EVT was performed in 72 (51.1%) patients. In the adjusted analysis, late EVT was significantly associated with a better outcome in the presence of clinical-ASPECTS mismatch (adjusted Odd Ratio, aOR=2.83; 95% confidence interval, CI: 1.48-5.58) but not in its absence (aOR=1.32; 95%CI: 0.61-2.84). The p-value for the interaction term between clinical-ASPECTS mismatch and late EVT was 0.073. ConclusionsIn our retrospective two-site analysis, late EVT seemed effective in the presence of a clinical-ASPECTS mismatch, but not in its absence. If confirmed in randomized trials, this finding could support the use of an ASPECTS-based selection for late EVT decisions, obviating the need for advanced imaging.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kaesmacher, Johannes; Mordasini, Pasquale; Hakim, Arsany; Arnold, Marcel; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1747-4949

Publisher:

SAGE

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

26 Apr 2021 10:15

Last Modified:

27 Apr 2021 01:34

Publisher DOI:

10.1177/17474930211009806

PubMed ID:

33787411

Uncontrolled Keywords:

ASPECTS Acute stroke therapy CT scan Endovascular treatment Ischaemic stroke Late time window

BORIS DOI:

10.48350/155903

URI:

https://boris.unibe.ch/id/eprint/155903

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