Objective To explore whether clinical outcomes following endovascular therapy (EVT) may differ according to infarct regions assessed by the Alberta Stroke Program Early CT Score (ASPECTS) in patients with large infarcts. Methods This post hoc analysis of the ANGEL-ASPECT study included patients with acute ischaemic stroke due to anterior circulation large vessel occlusion and large infarcts. Patients were randomised to EVT or standard medical therapy (SMT) and stratified based on ASPECTS into two groups: subcortical regions involvement (caudate, lenticular nucleus or internal capsule) and cortical regions involvement (cortical areas). The primary outcome was the 90-day modified Rankin Scale (mRS) score. ANGEL-ASPECT is signed up to ClinicalTrials.gov, NCT04551664 . Results Of 455 patients, 395 (86.81%) with subcortical regions and 60 (13.19%) cortical regions infarcts. EVT was associated with a favourable shift in 90-day mRS scores in the subcortical regions group (OR 1.65; 95% CI 1.16 to 2.34; p<0.001), whereas no statistically significant difference was observed in the cortical regions group (OR 1.47; 95% CI 0.59 to 3.66; p=0.09). In the subcortical regions group, EVT was associated with better outcomes in left-side infarcts (OR 1.73; 95% CI 1.04 to 2.89; p=0.04). Similar trends were not statistically significant in right-side infarcts (OR 1.57; 95% CI 0.97 to 2.53; p=0.07). Conclusions In this exploratory post hoc analysis, EVT was associated with more favourable functional outcomes in patients with subcortical region involvement, particularly in left-sided infarcts. However, no significant interaction between infarct location and treatment assignment was observed, and these findings should be considered hypothesis-generating.
Zhao et al. (Tue,) studied this question.
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