Endovascular Therapy and Outcomes Among Patients With Very Large Ischemic Core Stroke

Author:

Xie Dongjing1,Huang Jiacheng1,Fan Shitao1,Guo Changwei1,Sun Wenzhe1,Peng Zhouzhou1,Zhang Lingyu2,Yue Chengsong1,Qiu Zhongming1,Sang Hongfei3,Liang Dingwen4,Hu Jinrong1,Yang Jie1,Huang Jiandi1,Li Linyu1,Liu Juan1,Yang Dahong1,Liu Xiang1,Kong Weilin1,Liu Shuai1,Yang Qingwu1,Zi Wenjie1,Li Fengli1

Affiliation:

1. Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China

2. Department of Neurology, Weifang Medical University, Weifang, China

3. Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

4. Department of Neurology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China

Abstract

ImportanceThe association of endovascular therapy (EVT) with outcomes is unclear for patients with very low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) within 24 hours of stroke onset.ObjectiveTo explore the association of EVT with functional and safety outcomes among patients with ASPECTS of 0 to 2 scored with noncontrast computed tomography.Design, Setting, and ParticipantsThis cohort study used data from an ongoing, prospective, observational, nationwide registry including all patients treated at 38 stroke centers in China with an occlusion in the internal carotid artery or M1 or M2 segment of the middle cerebral artery within 24 hours of witnessed symptom onset. Patients with ASPECTS of 0 to 2 between November 1, 2021, and February 8, 2023, were included in analysis. Data were analyzed October to November 2023.ExposuresEVT vs standard medical treatment (SMT).Main Outcomes and MeasuresThe primary outcome was favorable functional outcome, defined as modified Rankin Scale score (mRS) of 0 to 3, at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH) within 48 hours and mortality at 90 days.ResultsA total of 245 patients (median [IQR] age, 71 [63-78] years; 118 [48%] women) with ASPECTS of 0 to 2 were included, of whom 111 patients (45.1%) received SMT and 135 patients (54.9%) received EVT. The EVT group had significantly greater odds of favorable functional outcome at 90 days than the SMT group (30 patients [22.2%] vs 11 patients [9.9%]; P = .01; adjusted odds ratio [aOR], 3.07 [95% CI, 1.29-7.31]; P = .01). Patients in the EVT group, compared with the SMT group, had significantly greater odds of any ICH (56 patients [41.5%] vs 16 patients [11.4%]; P < .001; aOR, 4.27 [95% CI, 2.19-8.35]; P < .001) and sICH (24 patients [17.8%] vs 1 patient [0.9%]; P < .001; aOR, 23.07 [95% CI, 2.99-177.79]; P = .003) within 48 hours. There were no differences between groups for 90-day mortality (80 patients [59.3%] vs 59 patients [53.2%]; P = .34; aOR, 1.38 [95% CI, 0.77-2.47]; P = .28). The results remained robust in the propensity score–matched analysis.Conclusions and RelevanceIn this cohort study of patients with very low ASPECTS based on NCCT within 24 hours of stroke onset, those treated with EVT had higher odds of a favorable functional outcome compared with those who received SMT. Randomized clinical trials are needed to assess these findings.

Publisher

American Medical Association (AMA)

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