Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in the Early and Extended Window

• Type of Material: Article
• Authors: Eyad Almallouhi, Medical University of South Carolina; Sami Al Kasab, Medical University of South Carolina; Zachary Hubbard, Medical University of South Carolina; Eric C Bass, Medical University of South Carolina; Guilherme Porto, Medical University of South Carolina; Ali Alawieh, Emory University; Reda Chalhoub, Medical University of South Carolina; Pascal M Jabbour, Thomas Jefferson University Hospitals; Robert M Starke, University of Miami Health System; Stacey Q Wolfe, Wake Forest School of Medicine; Adam S Arthur, University of Tennessee Health Science Center; Edgar Samaniego, University of Iowa Hospitals and Clinics; Ilko Maier, University Medical Center Göttingen; Brian Howard, Emory University; Ansaar Rai, West Virginia School of Medicine; Min S Park, University of Virginia; Justin Mascitelli, University of Texas Health Science Center at San Antonio; Marios Psychogios, University of Basel; Reade De Leacy, Mount Sinai Health System; Travis Dumont, University of Arizona; Michael R Levitt, University of Washington; Adam Polifka, University of Florida; Joshua Osbun, Washington University, St Louis; Roberto Crosa, Endovascular Neurological Center; Joon-Tae Kim, Chonnam National University Hospital; Walter Casagrande, Hospital Juan Fernandez; Shinichi Yoshimura, Hyogo College of Medicine; Charles Matouk, Yale School of Medicine; Peter T Kan, University of Texas Medical Branch; Richard W Williamson, Allegheny Health Network; Benjamin Gory, Centre Hospitalier Régional Universitaire de Nancy; Maxim Mokin, University of South Florida; Isabel Fragata, Hospital São José Centro Hospitalar; Osama Zaidat, Bon Secours Mercy Health St Vincent Medical Center; Albert J Yoo, Texas Stroke Institute; Alejandro M Spiotta, Medical University of South Carolina
• Language: English
• Date: 2021-12-08
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2021 Almallouhi E et al. JAMA Network Open.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2021.37708
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 4
• Issue: 12
• Start Page: e2137708
• End Page: e2137708
• Keywords: Science & Technology; GUIDELINES; ENDOVASCULAR TREATMENT; Life Sciences & Biomedicine; UPDATE; ASSOCIATION; METAANALYSIS; HEALTH-CARE PROFESSIONALS; EFFICACY; ACUTE ISCHEMIC-STROKE; SAFETY; General & Internal Medicine; EARLY MANAGEMENT; Medicine, General & Internal
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Importance: Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct. Objective: To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5. Design, Setting, and Participants: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid artery or M1 segment of the middle cerebral artery from January 1, 2016, to December 31, 2020. Patients were followed up for 90 days after intervention. The ASPECTS is a 10-point scoring system based on the extent of early ischemic changes on the baseline noncontrasted computed tomography scan, with a score of 10 indicating normal and a score of 0 indicating ischemic changes in all of the regions included in the score. Exposure: All patients underwent MT in one of the included centers. Main Outcomes and Measures: A multivariable regression model was used to assess factors associated with a favorable 90-day outcome (modified Rankin Scale score of 0-2), including interaction terms between an ASPECTS of 2 to 5 and receiving MT in the extended window (6-24 hours from symptom onset). Results: A total of 2345 patients who underwent MT were included (1175 women [50.1%]; median age, 72 years [IQR, 60-80 years]; 2132 patients [90.9%] had an ASPECTS of ≥6, and 213 patients [9.1%] had an ASPECTS of 2-5). At 90 days, 47 of the 213 patients (22.1%) with an ASPECTS of 2 to 5 had a modified Rankin Scale score of 0 to 2 (25.6% [45 of 176] of patients who underwent successful recanalization [modified Thrombolysis in Cerebral Ischemia score ≥2B] vs 5.4% [2 of 37] of patients who underwent unsuccessful recanalization; P =.007). Having a low ASPECTS (odds ratio, 0.60; 95% CI, 0.38-0.85; P =.002) and presenting in the extended window (odds ratio, 0.69; 95% CI, 0.55-0.88; P =.001) were associated with worse 90-day outcome after controlling for potential confounders, without significant interaction between these 2 factors (P =.64). Conclusions and Relevance: In this cohort study, more than 1 in 5 patients presenting with an ASPECTS of 2 to 5 achieved 90-day functional independence after MT. A favorable outcome was nearly 5 times more likely for patients with low ASPECTS who had successful recanalization. The association of a low ASPECTS with 90-day outcomes did not differ for patients presenting in the early vs extended MT window..