Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry
Background Current American guidelines are uncertain regarding endovascular treatment (EVT) for patients with acute ischemic stroke with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <6. Dutch guidelines do not specify ASPECTS‐based exclusion criteria for EVT. In this retros...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-05-01
|
| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.121.000199 |
| _version_ | 1797369950146396160 |
|---|---|
| author | Manon Kappelhof Ivo G.H. Jansen Johanna M. Ospel Albert J. Yoo Ludo F.M. Beenen Stefan D. Roosendaal Maxim J.H.L. Mulder Jasper M. Martens Alida A. Postma Diederik W.J. Dippel Wim H. van Zwam Olvert A. Berkhemer Henk A. Marquering Charles B.L.M. Majoie |
| author_facet | Manon Kappelhof Ivo G.H. Jansen Johanna M. Ospel Albert J. Yoo Ludo F.M. Beenen Stefan D. Roosendaal Maxim J.H.L. Mulder Jasper M. Martens Alida A. Postma Diederik W.J. Dippel Wim H. van Zwam Olvert A. Berkhemer Henk A. Marquering Charles B.L.M. Majoie |
| author_sort | Manon Kappelhof |
| collection | DOAJ |
| description | Background Current American guidelines are uncertain regarding endovascular treatment (EVT) for patients with acute ischemic stroke with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <6. Dutch guidelines do not specify ASPECTS‐based exclusion criteria for EVT. In this retrospective observational cohort study, we investigated outcomes of EVT in patients with low ASPECTS in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry. Methods ASPECTS was trichotomized into 0 to 2, 3 to 5, and 6 to 10, according to the grouping used in the ongoing trials. The effect of ASPECTS (granular and trichotomized) on 90‐day functional outcome (modified Rankin Scale score) and symptomatic intracranial hemorrhage was assessed with multivariable logistic regression. We included multiplicative interaction terms to evaluate treatment interaction between ASPECTS and reperfusion (extended thrombolysis in cerebral infarction score 2B‐3) as a proxy for EVT. Results Among 3075 included patients, higher ASPECTS was associated with improved functional outcome (granular: adjusted common odds ratio [acOR], 1.06; 95% CI, 1.02–1.10; trichotomized: acOR, 1.52; 95% CI, 1.23–1.87). Interaction with reperfusion was not significant (P=0.99 for granular, P=0.76 for trichotomized ASPECTS). All ASPECTS subgroups showed benefit of reperfusion (0–2 [n = 39]: acOR, 7.40; 95% CI, 1.41–18.68; 3–5 [n = 214]: acOR, 1.95; 95% CI, 1.13–3.34; 6–10 [n = 2822]: acOR, 2.41; 95% CI, 2.08–2.80). ASPECTS was not associated with symptomatic intracranial hemorrhage (granular: acOR, 1.00; 95% CI, 0.92–1.10, trichotomized: acOR, 0.92; 95% CI, 0.60–1.41). Conclusion Benefit of reperfusion was not modified by baseline ASPECTS. Patients in all ASPECTS subgroups showed benefit of reperfusion. These findings do not support withholding EVT on the basis of low ASPECTS only. |
| first_indexed | 2024-03-08T17:54:23Z |
| format | Article |
| id | doaj.art-86823c6892aa467496f8cb438d8880d5 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T17:54:23Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-86823c6892aa467496f8cb438d8880d52024-01-02T05:42:51ZengWileyStroke: Vascular and Interventional Neurology2694-57462022-05-012310.1161/SVIN.121.000199Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN RegistryManon Kappelhof0Ivo G.H. Jansen1Johanna M. Ospel2Albert J. Yoo3Ludo F.M. Beenen4Stefan D. Roosendaal5Maxim J.H.L. Mulder6Jasper M. Martens7Alida A. Postma8Diederik W.J. Dippel9Wim H. van Zwam10Olvert A. Berkhemer11Henk A. Marquering12Charles B.L.M. Majoie13Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsNico.Lab B.V. Amsterdam The NetherlandsDepartment of Radiology University Hospital of Basel Basel SwitzerlandDepartment of Radiology Texas Stroke Institute Dallas‐Fort Worth TX United StatesDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Neurology Erasmus Medical Center Rotterdam The NetherlandsDepartment of Radiology Rijnstate Hospital Arnhem The NetherlandsDepartment of Radiology and Nuclear Medicine Maastricht University Medical Center Maastricht The NetherlandsDepartment of Neurology Erasmus Medical Center Rotterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Maastricht University Medical Center Maastricht The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsBackground Current American guidelines are uncertain regarding endovascular treatment (EVT) for patients with acute ischemic stroke with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <6. Dutch guidelines do not specify ASPECTS‐based exclusion criteria for EVT. In this retrospective observational cohort study, we investigated outcomes of EVT in patients with low ASPECTS in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry. Methods ASPECTS was trichotomized into 0 to 2, 3 to 5, and 6 to 10, according to the grouping used in the ongoing trials. The effect of ASPECTS (granular and trichotomized) on 90‐day functional outcome (modified Rankin Scale score) and symptomatic intracranial hemorrhage was assessed with multivariable logistic regression. We included multiplicative interaction terms to evaluate treatment interaction between ASPECTS and reperfusion (extended thrombolysis in cerebral infarction score 2B‐3) as a proxy for EVT. Results Among 3075 included patients, higher ASPECTS was associated with improved functional outcome (granular: adjusted common odds ratio [acOR], 1.06; 95% CI, 1.02–1.10; trichotomized: acOR, 1.52; 95% CI, 1.23–1.87). Interaction with reperfusion was not significant (P=0.99 for granular, P=0.76 for trichotomized ASPECTS). All ASPECTS subgroups showed benefit of reperfusion (0–2 [n = 39]: acOR, 7.40; 95% CI, 1.41–18.68; 3–5 [n = 214]: acOR, 1.95; 95% CI, 1.13–3.34; 6–10 [n = 2822]: acOR, 2.41; 95% CI, 2.08–2.80). ASPECTS was not associated with symptomatic intracranial hemorrhage (granular: acOR, 1.00; 95% CI, 0.92–1.10, trichotomized: acOR, 0.92; 95% CI, 0.60–1.41). Conclusion Benefit of reperfusion was not modified by baseline ASPECTS. Patients in all ASPECTS subgroups showed benefit of reperfusion. These findings do not support withholding EVT on the basis of low ASPECTS only.https://www.ahajournals.org/doi/10.1161/SVIN.121.000199acute ischemic strokeAlberta Stroke Program Early Computed Tomography Scoreendovascular treatmentreperfusion therapies |
| spellingShingle | Manon Kappelhof Ivo G.H. Jansen Johanna M. Ospel Albert J. Yoo Ludo F.M. Beenen Stefan D. Roosendaal Maxim J.H.L. Mulder Jasper M. Martens Alida A. Postma Diederik W.J. Dippel Wim H. van Zwam Olvert A. Berkhemer Henk A. Marquering Charles B.L.M. Majoie Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry Stroke: Vascular and Interventional Neurology acute ischemic stroke Alberta Stroke Program Early Computed Tomography Score endovascular treatment reperfusion therapies |
| title | Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry |
| title_full | Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry |
| title_fullStr | Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry |
| title_full_unstemmed | Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry |
| title_short | Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry |
| title_sort | endovascular treatment may benefit patients with low baseline alberta stroke program early ct score results from the mr clean registry |
| topic | acute ischemic stroke Alberta Stroke Program Early Computed Tomography Score endovascular treatment reperfusion therapies |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.121.000199 |
| work_keys_str_mv | AT manonkappelhof endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT ivoghjansen endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT johannamospel endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT albertjyoo endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT ludofmbeenen endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT stefandroosendaal endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT maximjhlmulder endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT jaspermmartens endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT alidaapostma endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT diederikwjdippel endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT wimhvanzwam endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT olvertaberkhemer endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT henkamarquering endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry AT charlesblmmajoie endovasculartreatmentmaybenefitpatientswithlowbaselinealbertastrokeprogramearlyctscoreresultsfromthemrcleanregistry |