The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial-Reference-Cited by-同舟云学术

The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial

Published:2024-09-11 Issue: Volume: Page:
ISSN:1747-4930
Container-title:International Journal of Stroke
language:en
Short-container-title:International Journal of Stroke

Author:

Kaveeta Chitapa¹²^ORCID,Alhabli Ibrahim³,Bala Fouzi¹⁴^ORCID,Horn MacKenzie¹,Benali Faysal¹,Coutts Shelagh B¹³⁵^ORCID,Zafar Atif⁶,Bereznyakova Olena⁷,Khaw Alexander⁸,Khosravani Houman⁹,Hunter Gary¹⁰,Tkach Aleksander¹¹,Dowlatshahi Dar¹²^ORCID,Catanese Luciana¹³^ORCID,Bogiatzi Chrysi⁸,Appireddy Ramana¹⁴^ORCID,Buck Brian H¹⁵,Swartz Richard H⁹^ORCID,Sajobi Tolulope T¹⁵,Almekhlafi Mohammed¹³⁵,Demchuk Andrew M¹³,Ganesh Aravind¹⁵^ORCID,Menon Bijoy¹³⁵,Singh Nishita¹¹⁶^ORCID

Affiliation:

1. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

2. Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

3. Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

4. Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France

5. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

6. Division of Vascular Neurology, Department of Medicine, University of Toronto and St. Michael’s Hospital, Toronto, ON, Canada

7. Department of Clinical Neurosciences, Université de Montréal, Montreal, QC, Canada

8. London Health Sciences Centre and Western University, London, ON, Canada

9. Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

10. Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada

11. Department of Neuroscience, Kelowna General Hospital, Kelowna, BC, Canada

12. Department of Medicine, University of Ottawa and University of Ottawa Heart Institute, Ottawa, ON, Canada

13. Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

14. Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada

15. Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

16. Section of Neurology, Department of Internal Medicine, Health Sciences Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

Abstract

Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication. Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase. Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0–1, mRS 0–2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0–4 vs 5–7 vs 8–10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity. Results: Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65–84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17–19)) with anterior circulation stroke were included. mRS 0–1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0–4, 5–7, and 8–10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0–1 and mRS 0–2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0–1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes. Conclusion: Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase. Data access statement: Data shall made available on reasonable request from the PI (BMM).

Funder

Canadian Institutes of Health Research,

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/17474930241273561

Reference30 articles.

1. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy

2. How well does ASPECTS predict the outcome of acute stroke treated with IV tPA?

3. Importance of Early Ischemic Computed Tomography Changes Using ASPECTS in NINDS rtPA Stroke Study

4. Extent of Early Ischemic Changes on Computed Tomography (CT) Before Thrombolysis

5. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study