Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes Analysis From the STRATIS Registry

• Type of Material: Article
• Authors: Osama O Zaidat, St Vincent Mercy Hospital; David S Liebeskind, University of California Los Angeles; Ashuyosh P Jadhav, University of Pittsburgh; Santiago Ortega-Gutierrez, University of Iowa Health Care; Thanh N Nguyen, Boston Medical Center; Diogo Haussen, Emory University; Dileep R Yavagal, University of Miami; Michael T Froehler, Vanderbilt University; Reza Jahan, University of California Los Angeles; Raul Nogueira, Emory University; Tom L Yao, Norton Healthcare; Bader A Alenzi, Ohio State University; Saif Bushnaq, St Vincent Mercy Hospital; Nils H Mueller-Kronast, Advanced Neuroscience Network/Tenet South Florida, Boynton Beach (N.H.M.-K.)
• Language: English
• Date: 2021-07-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors and Stroke, Neurocritical Care, and Neurointerventional Research Center.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/STROKEAHA.120.032430
• Title of Journal or Parent Work: STROKE
• Volume: 52
• Issue: 7
• Start Page: 2220
• End Page: 2228
• Grant/Funding Information: This study was sponsored by Medtronic, Inc.
• Keywords: ENDOVASCULAR THERAPY; Cardiovascular System & Cardiology; INTRAARTERIAL TREATMENT; EFFICACY; age; Clinical Neurology; ischemic stroke; ACUTE ISCHEMIC-STROKE; TRIAL; large core infarction; DWI; Neurosciences & Neurology; thrombectomy; SAFETY; intracranial hemorrhage; Peripheral Vascular Disease; SELECTION; Science & Technology; Life Sciences & Biomedicine; cerebral infarction
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

Background and Purpose: This study investigates clinical outcomes after mechanical thrombectomy in adult patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) of 0 to 5. Methods: We included data from the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) from patients who underwent mechanical thrombectomy within 8 hours of symptom onset and had available ASPECTS data adjudicated by an independent core laboratory. Angiographic and clinical outcomes were collected, including successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), functional independence (modified Rankin Scale score 0-2), 90-day mortality, and symptomatic intracranial hemorrhage at 24 hours. Outcomes were stratified by ASPECTS scores and age. Results: Of the 984 patients enrolled, 763 had available ASPECTS data. Of these patients, 57 had ASPECTS of 0 to 5 with a median age of 63 years (interquartile range, 28-100), whereas 706 patients had ASPECTS of 6 to 10 with a median age of 70 years of age (interquartile range, 19-100). Ten patients had ASPECTS of 0 to 3 and 47 patients had ASPECTS of 4 to 5 at baseline. Successful reperfusion was achieved in 85.5% (47/55) in the ASPECTS of 0 to 5 group. Functional independence was achieved in 28.8% (15/52) in the ASPECTS of 0 to 5 versus 59.7% (388/650) in the 6 to 10 group (P<0.001). Mortality rates were 30.8% (16/52) in the ASPECTS of 0 to 5 and 13.4% (87/650) in the 6 to 10 group (P<0.001). sICH rates were 7.0% (4/57) in the ASPECTS of 0 to 5 and 0.9% (6/682) in the 6 to 10 group (P<0.001). No patients aged >75 years with ASPECTS of 0 to 5 (0/12) achieved functional independence versus 44.8% (13/29) of those age ≤65 (P=0.005). Conclusions: Patients <65 years of age with large core infarction (ASPECTS 0-5) have better rates of functional independence and lower rates of mortality compared with patients >75 years of age. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239640.