Thrombectomy in ischemic stroke patients with alberta stroke program early computed tomography score 4-5 and 0-3: Factors associated with favorable outcome.

Autor: Feyen L; Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany; University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Germany, Heusnerstraße 40, 42283, Wuppertal. Electronic address: ludger.feyen@helios-gesundheit.de., Kniep H; Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany., Blockhaus C; Heart Centre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, Witten 58448, Germany., Weinzierl M; Department of Neurosurgery, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany., Katoh M; Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany., Haage P; University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany., Rohde S; University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany; German Society of Interventional Radiology and Minimal Invasive Therapy, German Society of Interventional Radiology and Minimal Invasive Therapy (DeGIR) and German Society of Neuroradiology (DGNR), Ernst Reuter Platz 10, Berlin 10587, Germany., Münnich N; University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany; Department of Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2023 Aug; Vol. 32 (8), pp. 107104. Date of Electronic Publication: 2023 May 06.
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107104
Abstrakt: Objectives: Recently published results of the ANGEL-ASPECT and SELECT2 trials suggest that stroke patients presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) benefit from mechanical thrombectomy. Purpose of this retrospective study was to identify factors that are associated with a favorable outcome in patients with low ASPECTS of 4-5 and 0-3 undergoing mechanical thrombectomy.
Material and Methods: All patients reported in the quality registry of the German Society for Neuroradiology that were treated between 2018 and 2020 were analyzed. Favorable outcome was defined as a National Institute of Health Stroke Scale (NIHSS) score of less than 9 at dismissal. Successful recanalization was defined as Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b. Multivariable logistic regression analyses were performed to assess the association of baseline and treatment variables with favorable outcome.
Results: 621 patients were included in the analysis, thereof 495 with ASPECTS 4-5 and 126 with ASPECTS 0-3. In patients with ASPECTS 4-5patients with favorable outcome had less severe neurological symptoms at admission with median NIHSS of 15 vs. 18 (p<0.001), had less often wake-up strokes (44% vs. 81%, p<0.001), received more often iv-lysis (37% vs. 30%, p<0.001), had more often conscious sedation (29% vs. 16%, p<0.001), had a higher rate of successful recanalization (94% vs. 66% and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.89-0.91) and successful recanalization (aOR 3.96, CI 2-8.56) were associated with favorable outcome. For ASPECTS 0-3, patients with favorable outcome had lower median NIHSS at admission (16 vs. 18 (p<0.001), lower number of passes (1 vs. 3, p=0.003) and a higher rate of successful recanalization (94% vs. 66%, p<0.001) and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.81-0.94) and successful recanalization, (aOR 11.19, CI 3.19-55.53), were associated with favorable outcome.
Conclusion: Full recanalization with low groin punction to recanalization times and low number of passes were associated with favorable outcome in patients with low ASPECTS.
Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare that are relevant to the content of this article.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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