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Author Notes:

Sami Al Kasab, MD, Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC 29425. Email: alkasab@musc.edu

Dr Al Kasab had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Almallouhi and Al Kasab contributed equally as co–first authors.Concept and design: Almallouhi, Al Kasab, Chalhoub, Starke, Zaidat, Yoo, Spiotta. Acquisition, analysis, or interpretation of data: Almallouhi, Al Kasab, Hubbard, Bass, Porto, Alawieh, Chalhoub, Jabbour, Starke, Wolfe, Arthur, Samaniego, Maier, Howard, Rai, Park, Mascitelli, Psychogios, De Leacy, Dumont, Levitt, Polifka, Osbun, Crosa, Kim, Casagrande, Yoshimura, Matouk, Kan, Williamson, Gory, Mokin, Fragata, Zaidat, Spiotta. Drafting of the manuscript: Almallouhi, Al Kasab, Hubbard, Porto, Starke, Rai. Critical revision of the manuscript for important intellectual content: Almallouhi, Al Kasab, Bass, Porto, Alawieh, Chalhoub, Jabbour, Starke, Wolfe, Arthur, Samaniego, Maier, Howard, Park, Mascitelli, Psychogios, De Leacy, Dumont, Levitt, Polifka, Osbun, Crosa, Kim, Casagrande, Yoshimura, Matouk, Kan, Williamson, Gory, Mokin, Fragata, Zaidat, Yoo, Spiotta. Statistical analysis: Almallouhi, Chalhoub, Casagrande. Obtained funding: Alawieh. Administrative, technical, or material support: Hubbard, Bass, Porto, Alawieh, Chalhoub, Starke, Arthur, Samaniego, Maier, Howard, Levitt, Crosa, Kan, Williamson, Mokin, Spiotta. Supervision: Al Kasab, Alawieh, Jabbour, Starke, Arthur, Psychogios, Osbun, Zaidat, Spiotta.

Dr Samaniego reported receiving personal fees from Microvention, Medtronic, and Rapid Medical outside the submitted work. Dr Rai reported receiving personal fees from Stryker Neurovascular, Cerenovus, and Microvention outside the submitted work. Dr Park reported receiving personal fees from Medtronic outside the submitted work. Dr Mascitelli reported serving as a consultant for Stryker outside the submitted work. Dr De Leacy reported serving on the scientific advisory board for Cerenovus outside the submitted work. Dr Levitt reported receiving grants from Medtronic, Stryker, and Philips Volcano; serving as a consultant for Medtronic, Minnetronix, and Metis Innovative; and holding equity interest in Synchron, Cerebrotech, and eLoupes outside the submitted work. Dr Polifka reported serving as a consultant for Depuy Synthes outside the submitted work. Dr Osbun reported receiving personal fees from Microvention, Medtronic, and Terumo outside the submitted work. Dr Yoshimura reported receiving personal fees from Boehringer Ingelheim, Daiichi Sankyo, Bayer, Bristol Meyers Squibb, Stryker, Medtronic, Johnson & Johnson, Terumo, and Biomedical Solutions during the conduct of the study and personal fees from Kaneka Medics outside the submitted work. Dr Mokin reported serving as a consultant for Medtronic and Cerenovus and holding stock options in BrainQ, Endostream, Serenity Medical, and Synchron. Dr Zaidat reported receiving grants from Medtronic, Stryker, Penumbra, and Cerenovous; and serving as a consultant for Medtronic, Stryker, Penumbra, and Cerenovous outside the submitted work; in addition, Dr Zaidat had a patent for an ischemic stroke device issued and a patent for a galaxy therapeutics aneurysm device issued. Dr Yoo reported receiving grants from Cerenovus, Penumbra, Medtronic, and Stryker and personal fees from Vesalio and being an equity shareholder in Insera outside the submitted work. Dr Spiotta reported receiving personal fees from Penumbra, Terumo, and Stryker and nonfinancial support from Rapid AI outside the submitted work. No other disclosures were reported.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • ACUTE ISCHEMIC-STROKE
  • HEALTH-CARE PROFESSIONALS
  • ENDOVASCULAR TREATMENT
  • EARLY MANAGEMENT
  • METAANALYSIS
  • ASSOCIATION
  • GUIDELINES
  • EFFICACY
  • SAFETY
  • UPDATE

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

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Journal Title:

JAMA NETWORK OPEN

Volume:

Volume 4, Number 12

Publisher:

, Pages e2137708-e2137708

Type of Work:

Article | Final Publisher PDF

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..

Copyright information:

2021 Almallouhi E et al. JAMA Network Open.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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