Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct
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Published:2024-01-01
Issue:1
Volume:81
Page:30
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ISSN:2168-6149
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Container-title:JAMA Neurology
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language:en
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Short-container-title:JAMA Neurol
Author:
Sun Dapeng12, Guo Xu3, Nguyen Thanh N.4, Pan Yuesong12, Ma Gaoting5, Tong Xu12, Raynald 12, Wang Mengxing2, Ma Ning12, Gao Feng124, Mo Dapeng124, Huo Xiaochuan3, Miao Zhongrong12, Yuan Guangxiong6, Han Hongxing6, Chen Wenhuo6, Wei Ming6, Zhang Jiangang6, Zhou Zhimin6, Yao Xiaoxi6, Wang Guoqing6, Song Weigen6, Cai Xueli6, Nan Guangxian6, Li Di6, Wang Alvin Yi-Chou6, Ling Wentong6, Cai Chuwei6, Wen Changming6, Wang En6, Zhang Liyong6, Jiang Changchun6, Liu Yajie6, Liao Geng6, Chen Xiaohui6, Li Tianxiao6, Liu Shudong6, Li Jinglun6, Sun Yaxuan6, Xu Na6, Gao Zong'en6, Ju Dongsheng6, Song Cunfeng6, Xuan Jinggang6, Zhou Feng6, Shi Qing6, Luo Jun6, Liu Yan6, Guo Zaiyu6, Li Tong6, Zheng Hongbo6, Dai Linzhi6, Zhao Junfeng6, Gui Liqiang6, Geng Xiaokun6, Tang Yufeng6, Yin Congguo6, Yang Hua6, Wang Yongjun6, Wang Yilong6, Liu Liping6, Liebeskind David6, Ren Zeguang6, Pereira Vitor6, Ji Xunming6, Dong Qiang6, Xu Anding6, Liu Xinfeng6, Yang Qingwu6, Jing Jing6, Zhang Zhe6, Zhang Yingkui6, Wu Wei6, Qi Zhongqi6, Li Shuo6, Yu Zequan6, Zhang Jingyu6, Chen Fangguang6, Li Kangyue6, Zhang Kai6, Hu Mingkai6, Liu Jianmin6, Yao Chen6, Chen Kangning6, Fang Kun6, Song Bo6, Dong Yi6, An Ruiyang6, Sun Yuying6, Wu Yanan6, Yu Chunlai6, Zheng Shuangcheng6, Jin Aoming6, Xiang Xianglong6, Yan Hongyi6, He Yuanling6, Li Chunyang6, Kong Weixia6, Chen Yuhuan6, Guo Chenhao6, Ji Fengjie6, Ji Pengshan6, Liu Lei6, Lu Xinghua6, Luo Guangkuo6, Wang Nanjing6, Zhang Yu6, Liu Bo6, Yang Jian6, Deng Jingjing6, Wang Juan6, Wang Wanru6, Yu Hang6, Cui Le6, Liu Wenwen6, Wang Ziyong6, Zhao Xia6, Zhou Zhou6,
Affiliation:
1. Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China 2. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China 3. Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China 4. Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts 5. Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China 6. for the ANGEL-ASPECT Study Group
Abstract
ImportanceEndovascular therapy (EVT) demonstrated better outcomes compared with medical management in recent randomized clinical trials (RCTs) of patients with large infarct.ObjectiveTo compare outcomes of EVT vs medical management across different strata of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and infarct core volume in patients with large infarct.Design, Setting, and ParticipantsThis prespecified secondary analysis of subgroups of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core (ANGEL-ASPECT) RCT included patients from 46 stroke centers across China between October 2, 2020, and May 18, 2022. Participants were enrolled within 24 hours of symptom onset and had ASPECTS of 3 to 5 or 0 to 2 and infarct core volume of 70 to 100 mL. Patients were divided into 3 groups: ASPECTS of 3 to 5 with infarct core volume less than 70 mL, ASPECTS of 3 to 5 with infarct core volume of 70 mL or greater, and ASPECTS of 0 to 2.InterventionsEndovascular therapy or medical management.Main Outcomes and MeasuresThe primary outcome was the ordinal 90-day modified Rankin Scale (mRS) score.ResultsThere were 455 patients in the trial; median age was 68 years (IQR, 60-73 years), and 279 (61.3%) were male. The treatment effect did not vary significantly across the 3 baseline imaging subgroups (P = .95 for interaction). The generalized odds ratio for the shift in the 90-day mRS distribution toward better outcomes with EVT vs medical management was 1.40 (95% CI, 1.06-1.85; P = .01) in patients with ASPECTS of 3 to 5 and infarct core volume less than 70 mL, 1.22 (95% CI, 0.81-1.83; P = .23) in patients with ASPECTS of 3 to 5 and infarct core volume of 70 mL or greater, and 1.59 (95% CI, 0.89-2.86; P = .09) in patients with ASPECTS of 0 to 2.Conclusions and RelevanceIn this study, no significant interaction was found between baseline imaging status and the benefit of EVT compared with medical management in patients with large infarct core volume. However, estimates within subgroups were underpowered. A pooled analysis of large core trials stratified by ASPECTS and infarct core volume strata is warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT04551664
Publisher
American Medical Association (AMA)
Subject
Neurology (clinical)
Cited by
2 articles.
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