Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry-Reference-Cited by-同舟云学术

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

Published:2021-07 Issue:7 Volume:52 Page:2220-2228
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Zaidat Osama O.¹^ORCID,Liebeskind David S.²^ORCID,Jadhav Ashutosh P.³^ORCID,Ortega-Gutierrez Santiago⁴^ORCID,Nguyen Thanh N.⁵^ORCID,Haussen Diogo C.⁶^ORCID,Yavagal Dileep R.⁷^ORCID,Froehler Michael T.⁸,Jahan Reza⁹,Nogueira Raul G.⁶^ORCID,Yao Tom L.¹⁰,Alenzi Bader A.¹¹,Bushnaq Saif¹,Mueller-Kronast Nils H.¹²

Affiliation:

1. Neuroscience Institute, St Vincent Mercy Hospital, Toledo, OH (O.O.Z., S.B.).

2. Neurovascular Imaging Research Core and Stroke Center, Department of Neurology (D.S.L.), University of California Los Angeles.

3. Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J.).

4. Departments of Neurology, Neurosurgery and Radiology, University of Iowa Health Care, Carver College of Medicine (S.O.-G.).

5. Division of Interventional Neuroradiology and Interventional Neurology, Boston Medical Center, MA (T.N.N.).

6. Department of Neurology, Emory University, Atlanta, GA (D.C.H., R.G.N.).

7. Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.).

8. Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN (M.T.F.).

9. Department of Radiology (R.J.), University of California Los Angeles.

10. Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y.).

11. Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (B.A.A.).

12. Advanced Neuroscience Network/Tenet South Florida, Boynton Beach (N.H.M.-K.).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.032430

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