Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0–5

Autor: Panagiotis Chaloulos-Iakovidis, L. Pierot, Christian Maegerlein, Urs Fischer, Patrik Michel, Steven D. Hajdu, Joanna D. Schaafsma, Pasquale Mordasini, Benjamin Friedrich, Vincent Costalat, Jan Gralla, Amel Benali, Marc Ribo, Vitor Mendes Pereira, Manuel Requena, Johannes Kaesmacher, Matthias Gawlitza, Leonidas Panos
Přispěvatelé: Inselspital Bern, Bern University Hospital [Berne] (Inselspital), Service of Neurology [CHUV, Lausanne, Switzerland], Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Vall d'Hebron University Hospital [Barcelona], Klinikums rechts der Isar, Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Toronto Western Hospital, Centre Hospitalier Universitaire de Reims (CHU Reims)
Rok vydání: 2019
Předmět:
Solitaire Cryptographic Algorithm
medicine.medical_specialty
Aged
Aged
80 and over
Brain Ischemia/diagnostic imaging
Brain Ischemia/surgery
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Registries
Stroke/diagnostic imaging
Stroke/surgery
Thrombectomy/methods
Tomography
X-Ray Computed
Treatment Outcome
infarction
magnetic resonance imaging
reperfusion
selection for treatment
thrombectomy
tomography
[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging
[SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology
Original Contributions
Clinical Sciences
Infarction
610 Medicine & health
030218 nuclear medicine & medical imaging
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Modified Rankin Scale
Internal medicine
Medicine
Stroke
Advanced and Specialized Nursing
Intracerebral hemorrhage
business.industry
Odds ratio
medicine.disease
ddc
3. Good health
Clinical trial
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Zdroj: Stroke
Stroke, American Heart Association, 2019, 50 (4), pp.880-888. ⟨10.1161/STROKEAHA.118.023465⟩
Stroke, vol. 50, no. 4, pp. 880-888
Kaesmacher, Johannes; Chaloulos-Iakovidis, Panagiotis; Panos, Leonidas; Mordasini, Pasquale; Michel, Patrik; Hajdu, Steven D; Ribo, Marc; Requena, Manuel; Maegerlein, Christian; Friedrich, Benjamin; Costalat, Vincent; Benali, Amel; Pierot, Laurent; Gawlitza, Matthias; Schaafsma, Joanna; Mendes Pereira, Vitor; Gralla, Jan; Fischer, Urs (2019). Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke, 50(4), pp. 880-888. Wolters Kluwer Health 10.1161/STROKEAHA.118.023465
ISSN: 1524-4628
0039-2499
Popis: Supplemental Digital Content is available in the text.
Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
Databáze: OpenAIRE
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