What question did this study set out to answer?

To compare the efficacy and safety of endovascular therapy according to baseline infarct size measured by ASPECTS (≤3 vs 4 to 5) in patients with acute large-vessel occlusion stroke.

October 10, 2022JAMA NeurologyOpen Access

Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion

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Authors

KUKazutaka UchidaHyogo Medical University SSSeigo ShindoJapanese Red Cross Kumamoto Hospital SYShinichi YoshimuraNational Cerebral and Cardiovascular Center

Discussion

Member takes

Implication

Randomized trial reveals endovascular therapy improves outcomes in stroke patients with ASPECTS 4 to 5 but not 3 or less, suggesting baseline infarct size dictates treatment benefit.

Key Points

To compare the efficacy and safety of endovascular therapy according to baseline infarct size measured by ASPECTS (≤3 vs 4 to 5) in patients with acute large-vessel occlusion stroke.
Secondary analysis of the RESCUE-Japan LIMIT open-label randomized clinical trial (NCT03702413) across 45 stroke centers in Japan with 202 analyzed adults having acute ischemic stroke and ASPECTS 3 to 5.
Participants with occlusions in the internal carotid artery or middle cerebral artery M1 segment were randomized to endovascular therapy plus medical therapy or medical therapy alone, with 90-day follow-up.
In patients with ASPECTS 4 to 5, endovascular therapy significantly increased 90-day functional independence (mRS 0-3: 43.2% vs 7.7%; OR, 9.12; 95% CI, 2.80-29.70; interaction P = .01; ordinal shift common OR, 4.48; 95% CI, 2.07-9.71).
In patients with ASPECTS ≤3, endovascular therapy showed no significant difference in 90-day functional independence (mRS 0-3: 21.4% vs 18.0%; OR, 1.24; 95% CI, 0.47-3.26; ordinal shift common OR, 1.56; 95% CI, 0.79-3.10).
Endovascular therapy significantly increased the risk of intracranial hemorrhage in patients with ASPECTS ≤3 (OR, 4.14; 95% CI, 1.84-9.32), but not significantly in those with ASPECTS 4 to 5 (OR, 2.05; 95% CI, 0.89-4.73; interaction P = .24).

Cite This Study

Uchida et al. (2022) studied this question.

synapsesocial.com/papers/6a7cb3e34ec837fd6928a840 https://doi.org/10.1001/jamaneurol.2022.3285

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Implication

Randomized trial reveals endovascular therapy improves outcomes in stroke patients with ASPECTS 4 to 5 but not 3 or less, suggesting baseline infarct size dictates treatment benefit.

Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion

Discussion

Member takes

Implication

Key Points

Cite This Study

Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion

Discussion

Member takes

Implication

Key Points

Cite This Study

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