TY - JOUR
T1 - Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score
T2 - Results From the MR CLEAN Registry
AU - Kappelhof, Manon
AU - Jansen, Ivo G. H.
AU - Ospel, Johanna M.
AU - Yoo, Albert J.
AU - Beenen, Ludo F. M.
AU - Roosendaal, Stefan D.
AU - Mulder, Maxim J. H. L.
AU - Martens, Jasper M.
AU - Postma, Alida A.
AU - Dippel, Diederik W. J.
AU - van Zwam, Wim H.
AU - Berkhemer, Olvert A.
AU - Marquering, Henk A.
AU - Majoie, Charles B. L. M.
AU - MR CLEAN Registry Investigators
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background Current American guidelines are uncertain regarding endovascular treatment (EVT) for patients with acute ischemic stroke with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <6. Dutch guidelines do not specify ASPECTS-based exclusion criteria for EVT. In this retrospective observational cohort study, we investigated outcomes of EVT in patients with low ASPECTS in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry. Methods ASPECTS was trichotomized into 0 to 2, 3 to 5, and 6 to 10, according to the grouping used in the ongoing trials. The effect of ASPECTS (granular and trichotomized) on 90-day functional outcome (modified Rankin Scale score) and symptomatic intracranial hemorrhage was assessed with multivariable logistic regression. We included multiplicative interaction terms to evaluate treatment interaction between ASPECTS and reperfusion (extended thrombolysis in cerebral infarction score 2B-3) as a proxy for EVT. Results Among 3075 included patients, higher ASPECTS was associated with improved functional outcome (granular: adjusted common odds ratio [acOR], 1.06; 95% CI, 1.02-1.10; trichotomized: acOR, 1.52; 95% CI, 1.23-1.87). Interaction with reperfusion was not significant (P=0.99 for granular, P=0.76 for trichotomized ASPECTS). All ASPECTS subgroups showed benefit of reperfusion (0-2 [n = 39]: acOR, 7.40; 95% CI, 1.41-18.68; 3-5 [n = 214]: acOR, 1.95; 95% CI, 1.13-3.34; 6-10 [n = 2822]: acOR, 2.41; 95% CI, 2.08-2.80). ASPECTS was not associated with symptomatic intracranial hemorrhage (granular: acOR, 1.00; 95% CI, 0.92-1.10, trichotomized: acOR, 0.92; 95% CI, 0.60-1.41). Conclusion Benefit of reperfusion was not modified by baseline ASPECTS. Patients in all ASPECTS subgroups showed benefit of reperfusion. These findings do not support withholding EVT on the basis of low ASPECTS only.
AB - Background Current American guidelines are uncertain regarding endovascular treatment (EVT) for patients with acute ischemic stroke with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <6. Dutch guidelines do not specify ASPECTS-based exclusion criteria for EVT. In this retrospective observational cohort study, we investigated outcomes of EVT in patients with low ASPECTS in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry. Methods ASPECTS was trichotomized into 0 to 2, 3 to 5, and 6 to 10, according to the grouping used in the ongoing trials. The effect of ASPECTS (granular and trichotomized) on 90-day functional outcome (modified Rankin Scale score) and symptomatic intracranial hemorrhage was assessed with multivariable logistic regression. We included multiplicative interaction terms to evaluate treatment interaction between ASPECTS and reperfusion (extended thrombolysis in cerebral infarction score 2B-3) as a proxy for EVT. Results Among 3075 included patients, higher ASPECTS was associated with improved functional outcome (granular: adjusted common odds ratio [acOR], 1.06; 95% CI, 1.02-1.10; trichotomized: acOR, 1.52; 95% CI, 1.23-1.87). Interaction with reperfusion was not significant (P=0.99 for granular, P=0.76 for trichotomized ASPECTS). All ASPECTS subgroups showed benefit of reperfusion (0-2 [n = 39]: acOR, 7.40; 95% CI, 1.41-18.68; 3-5 [n = 214]: acOR, 1.95; 95% CI, 1.13-3.34; 6-10 [n = 2822]: acOR, 2.41; 95% CI, 2.08-2.80). ASPECTS was not associated with symptomatic intracranial hemorrhage (granular: acOR, 1.00; 95% CI, 0.92-1.10, trichotomized: acOR, 0.92; 95% CI, 0.60-1.41). Conclusion Benefit of reperfusion was not modified by baseline ASPECTS. Patients in all ASPECTS subgroups showed benefit of reperfusion. These findings do not support withholding EVT on the basis of low ASPECTS only.
KW - acute ischemic stroke
KW - Alberta Stroke Program Early Computed Tomography Score
KW - endovascular treatment
KW - reperfusion therapies
KW - ACUTE ISCHEMIC-STROKE
KW - COMPUTED-TOMOGRAPHY
KW - MECHANICAL THROMBECTOMY
KW - INTRAARTERIAL TREATMENT
KW - THERAPY
KW - METAANALYSIS
KW - RELIABILITY
KW - PREDICTION
KW - MANAGEMENT
KW - EFFICACY
U2 - 10.1161/SVIN.121.000199
DO - 10.1161/SVIN.121.000199
M3 - Article
SN - 2694-5746
VL - 2
JO - Stroke: vascular and interventional neurology
JF - Stroke: vascular and interventional neurology
IS - 3
M1 - e000199
ER -