Endovascular reperfusion outcomes in patients with a stroke and low ASPECTS is highly dependent on baseline infarct volumes
| العنوان: | Endovascular reperfusion outcomes in patients with a stroke and low ASPECTS is highly dependent on baseline infarct volumes |
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| المؤلفون: | Leonardo Pisani, Michael R Frankel, Raul G Nogueira, Diogo C Haussen, Clara M Barreira, Gabriel M Rodrigues, Mehdi Bouslama |
| المصدر: | Journal of NeuroInterventional Surgery. 14:117-121 |
| بيانات النشر: | BMJ, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Poor prognosis, Perfusion scanning, 030204 cardiovascular system & hematology, Alberta, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, Humans, Medicine, In patient, Stroke, Retrospective Studies, Thrombectomy, business.industry, Endovascular Procedures, Confounding, General Medicine, medicine.disease, Treatment Outcome, Cerebral blood flow, Infarction, Reperfusion, Infarct volume, Cardiology, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery |
| الوصف: | BackgroundPatients with large vessel occlusion stroke (LVOS) and a low Alberta Stroke Program Early CT Score (ASPECTS) are often not offered endovascular therapy (ET) as they are thought to have a poor prognosis.ObjectiveTo compare the outcomes of patients with low and high ASPECTS undergoing ET based on baseline infarct volumes.MethodsReview of a prospectively collected endovascular database at a tertiary care center between September 2010 and March 2020. All patients with anterior circulation LVOS and interpretable baseline CT perfusion (CTP) were included. Subjects were divided into groups with low ASPECTS (0–5) and high ASPECTS (6-10) and subsequently into limited and large CTP-core volumes (cerebral blood flow 30% >70 cc). The primary outcome measure was the difference in rates of 90-day good outcome as defined by a modified Rankin Scale (mRS) score of 0 to 2 across groups.Results1248 patients fit the inclusion criteria. 125 patients had low ASPECTS, of whom 16 (12.8%) had a large core (LC), whereas 1123 patients presented with high ASPECTS, including 29 (2.6%) patients with a LC. In the category with a low ASPECTS, there was a trend towards lower rates of functional independence (90-day modified Rankin Scale (mRS) score 0-2) in the LC group (18.8% vs 38.9%, p=0.12), which became significant after adjusting for potential confounders in multivariable analysis (aOR=0.12, 95% CI 0.016 to 0.912, p=0.04). Likewise, LC was associated with significantly lower rates of functional independence (31% vs 51.9%, p=0.03; aOR=0.293, 95% CI 0.095 to 0.909, p=0.04) among patients with high ASPECTS.ConclusionsOutcomes may vary significantly in the same ASPECTS category depending on infarct volume. Patients with ASPECTS ≤5 but baseline infarct volumes ≤70 cc may achieve independence in nearly 40% of the cases and thus should not be excluded from treatment. |
| تدمد: | 1759-8486 1759-8478 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::36a2c586aa2bba587f22075b23ded810 https://doi.org/10.1136/neurintsurg-2020-017184 |
| رقم الأكسشن: | edsair.doi.dedup.....36a2c586aa2bba587f22075b23ded810 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 17598486 17598478 |
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