Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT
Background and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy o...
| Huvudupphovsmän: | , , , , , , , , , , , , , , , , , , |
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| Materialtyp: | Artikel |
| Språk: | English |
| Publicerad: |
Korean Stroke Society
2023-09-01
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| Serie: | Journal of Stroke |
| Ämnen: | |
| Länkar: | http://www.j-stroke.org/upload/pdf/jos-2023-01641.pdf |
| _version_ | 1827787155220463616 |
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| author | Fumihiro Sakakibara Kazutaka Uchida Shinichi Yoshimura Nobuyuki Sakai Hiroshi Yamagami Kazunori Toyoda Yuji Matsumaru Yasushi Matsumoto Kazumi Kimura Reiichi Ishikura Manabu Inoue Kumiko Ando Atsushi Yoshida Kanta Tanaka Takeshi Yoshimoto Junpei Koge Mikiya Beppu Manabu Shirakawa Takeshi Morimoto |
| author_facet | Fumihiro Sakakibara Kazutaka Uchida Shinichi Yoshimura Nobuyuki Sakai Hiroshi Yamagami Kazunori Toyoda Yuji Matsumaru Yasushi Matsumoto Kazumi Kimura Reiichi Ishikura Manabu Inoue Kumiko Ando Atsushi Yoshida Kanta Tanaka Takeshi Yoshimoto Junpei Koge Mikiya Beppu Manabu Shirakawa Takeshi Morimoto |
| author_sort | Fumihiro Sakakibara |
| collection | DOAJ |
| description | Background and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT. |
| first_indexed | 2024-03-11T16:45:31Z |
| format | Article |
| id | doaj.art-a6ceae6e7b46472dad3e9ba5e46e00d8 |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-03-11T16:45:31Z |
| publishDate | 2023-09-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-a6ceae6e7b46472dad3e9ba5e46e00d82023-10-23T00:18:04ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052023-09-0125338839810.5853/jos.2023.01641503Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMITFumihiro Sakakibara0Kazutaka Uchida1Shinichi Yoshimura2Nobuyuki Sakai3Hiroshi Yamagami4Kazunori Toyoda5Yuji Matsumaru6Yasushi Matsumoto7Kazumi Kimura8Reiichi Ishikura9Manabu Inoue10Kumiko Ando11Atsushi Yoshida12Kanta Tanaka13Takeshi Yoshimoto14Junpei Koge15Mikiya Beppu16Manabu Shirakawa17Takeshi Morimoto18 Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, JapanBackground and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.http://www.j-stroke.org/upload/pdf/jos-2023-01641.pdfacute ischemic strokeneuroimagingendovascular therapylarge ischemic corelarge vessel occlusion |
| spellingShingle | Fumihiro Sakakibara Kazutaka Uchida Shinichi Yoshimura Nobuyuki Sakai Hiroshi Yamagami Kazunori Toyoda Yuji Matsumaru Yasushi Matsumoto Kazumi Kimura Reiichi Ishikura Manabu Inoue Kumiko Ando Atsushi Yoshida Kanta Tanaka Takeshi Yoshimoto Junpei Koge Mikiya Beppu Manabu Shirakawa Takeshi Morimoto Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT Journal of Stroke acute ischemic stroke neuroimaging endovascular therapy large ischemic core large vessel occlusion |
| title | Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT |
| title_full | Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT |
| title_fullStr | Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT |
| title_full_unstemmed | Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT |
| title_short | Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT |
| title_sort | mode of imaging study and endovascular therapy for a large ischemic core insights from the rescue japan limit |
| topic | acute ischemic stroke neuroimaging endovascular therapy large ischemic core large vessel occlusion |
| url | http://www.j-stroke.org/upload/pdf/jos-2023-01641.pdf |
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