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Tanaka K, Kaveeta C, Pensato U, Zhang J, Bala F, Alhabli I, Horn M, Ademola A, Almekhlafi M, Ganesh A, Buck B, Tkach A, Catanese L, Dowlatshahi D, Shankar J, Poppe AY, Shamy M, Qiu W, Swartz RH, Hill MD, Sajobi TT, Menon BK, Demchuk AM, Singh N. Combining Early Ischemic Change and Collateral Extent for Functional Outcomes After Endovascular Therapy: An Analysis From AcT Trial. Stroke 2024; 55:1758-1766. [PMID: 38785076 DOI: 10.1161/strokeaha.123.046056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Early ischemic change and collateral extent are colinear with ischemic core volume (ICV). We investigated the relationship between a combined score using the Alberta Stroke Program Early Computed Tomography Score and multiphase computed tomography angiography (mCTA) collateral extent, named mCTA-ACE score, on functional outcomes in endovascular therapy-treated patients. METHODS We performed a post hoc analysis of a subset of endovascular therapy-treated patients from the Alteplase Compared to Tenecteplase trial which was conducted between December 2019 and January 2022 at 22 centers across Canada. Ten-point mCTA collateral corresponding to M2 to M6 regions of the Alberta Stroke Program Early Computed Tomography Score grid was evaluated as 0 (poor), 1 (moderate), or 2 (normal) and additively combined with the 10-point Alberta Stroke Program Early Computed Tomography Score to produce a 20-point mCTA-ACE score. We investigated the association of mCTA-ACE score with modified Rankin Scale score ≤2 and return to prestroke level of function at 90 to 120 days using mixed-effects logistic regression. In the subset of patients who underwent baseline computed tomography perfusion imaging, we compared the mCTA-ACE score and ICV for outcome prediction. RESULTS Among 1577 intention-to-treat population in the trial, 368 (23%; 179 men; median age, 73 years) were included, with Alberta Stroke Program Early Computed Tomography Score, mCTA collateral, and combination of both (mCTA-ACE score: median [interquartile range], 8 [7-10], 9 [8-10], and 17 [16-19], respectively). The probability of modified Rankin Scale score ≤2 and return to prestroke level of function increased for each 1-point increase in mCTA-ACE score (odds ratio, 1.16 [95% CI, 1.06-1.28] and 1.22 [95% CI, 1.06-1.40], respectively). Among 173 patients in whom computed tomography perfusion data was assessable, the mCTA-ACE score was inversely correlated with ICV (ρ=-0.46; P<0.01). The mCTA-ACE score was comparable to ICV to predict a modified Rankin Scale score ≤2 and return to prestroke level of function (C statistics 0.71 versus 0.69 and 0.68 versus 0.64, respectively). CONCLUSIONS The mCTA-ACE score had a significant positive association with functional outcomes after endovascular therapy and had a similar predictive performance as ICV.
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Affiliation(s)
- Koji Tanaka
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Chitapa Kaveeta
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (C.K.)
| | - Umberto Pensato
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.)
- IRCCS Humanitas Research Hospital, Milan, Italy (U.P.)
| | - Jianhai Zhang
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Fouzi Bala
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France (F.B.)
| | - Ibrahim Alhabli
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (B.B.)
| | - Aleksander Tkach
- Department of Neurosciences, Kelowna General Hospital, BC, Canada (A.T.)
| | - Luciana Catanese
- Department of Medicine, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.)
| | - Jai Shankar
- Department of Radiology, Health Sciences Center (J.S.), University of Manitoba, Winnipeg, Canada
| | - Alexandre Y Poppe
- Department of Clinical Neurosciences, Université de Montréal, QC, Canada (A.Y.P.)
| | - Michel Shamy
- Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.)
| | - Wu Qiu
- Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China (W.Q.)
| | - Richard H Swartz
- Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S.)
| | - Michael D Hill
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Medicine (M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada
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Güney R, Potreck A, Neuberger U, Schmitt N, Purrucker J, Möhlenbruch MA, Bendszus M, Seker F. Association of Carotid Artery Disease with Collateralization and Infarct Growth in Patients with Acute Middle Cerebral Artery Occlusion. AJNR Am J Neuroradiol 2024; 45:574-580. [PMID: 38575322 PMCID: PMC11288550 DOI: 10.3174/ajnr.a8180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE Collaterals are important in large vessel occlusions (LVO), but the role of carotid artery disease (CAD) in this context remains unclear. This study aimed to investigate the impact of CAD on intracranial collateralization and infarct growth after thrombectomy in LVO. MATERIALS AND METHODS All patients who underwent thrombectomy due to M1 segment occlusion from 01/2015 to 12/2021 were retrospectively included. Internal carotid artery stenosis according to NASCET was assessed on the affected and nonaffected sides. Collaterals were assessed according to the Tan score. Infarct growth was quantified by comparing ASPECTS on follow-up imaging with baseline ASPECTS. RESULTS In total, 709 patients were included, 118 (16.6%) of whom presented with CAD (defined as severe stenosis ≥70% or occlusion ipsilaterally), with 42 cases (5.9%) being contralateral. Good collateralization (Tan 3) was present in 56.5% of the patients with ipsilateral CAD and 69.1% of the patients with contralateral CAD. The ipsilateral stenosis grade was an independent predictor of good collateral supply (adjusted OR: 1.01; NASCET point, 95% CI: 1.00-1.01; P = .009), whereas the contralateral stenosis grade was not (P = .34). Patients with ipsilateral stenosis of ≥70% showed less infarct growth (median ASPECTS decay: 1; IQR: 0-2) compared with patients with 0%-69% stenosis (median: 2; IQR: 1-3) (P = .005). However, baseline ASPECTS was significantly lower in patients with stenosis of 70%-100% (P < .001). The results of a multivariate analysis revealed that increasing ipsilateral stenosis grade (adjusted OR: 1.0; 95% CI: 0.99-1.00; P = .004) and good collateralization (adjusted OR: 0.5; 95% CI: 0.4-0.62; P < .001) were associated with less infarct growth. CONCLUSIONS CAD of the ipsilateral ICA is an independent predictor of good collateral supply. Patients with CAD tend to have larger baseline infarct size but less infarct growth.
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Affiliation(s)
- Resul Güney
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
| | - Arne Potreck
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
| | - Ulf Neuberger
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
| | - Niclas Schmitt
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Purrucker
- Departments of Neurology (J.P.), Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
| | - Fatih Seker
- From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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Samaniego EA, Boltze J, Lyden PD, Hill MD, Campbell BCV, Silva GS, Sheth KN, Fisher M, Hillis AE, Nguyen TN, Carone D, Favilla CG, Deljkich E, Albers GW, Heit JJ, Lansberg MG. Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke. Stroke 2023; 54:3190-3201. [PMID: 37942645 PMCID: PMC10841844 DOI: 10.1161/strokeaha.123.044985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STAIR XII (12th Stroke Treatment Academy Industry Roundtable) included a workshop to discuss the priorities for advancements in neuroimaging in the diagnostic workup of acute ischemic stroke. The workshop brought together representatives from academia, industry, and government. The participants identified 10 critical areas of priority for the advancement of acute stroke imaging. These include enhancing imaging capabilities at primary and comprehensive stroke centers, refining the analysis and characterization of clots, establishing imaging criteria that can predict the response to reperfusion, optimizing the Thrombolysis in Cerebral Infarction scale, predicting first-pass reperfusion outcomes, improving imaging techniques post-reperfusion therapy, detecting early ischemia on noncontrast computed tomography, enhancing cone beam computed tomography, advancing mobile stroke units, and leveraging high-resolution vessel wall imaging to gain deeper insights into pathology. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed. A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes.
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Affiliation(s)
- Edgar A. Samaniego
- Department of Neurology, Radiology and Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Johannes Boltze
- School of Life Sciences, The University of Warwick, Coventry, United Kingdom
| | - Patrick D. Lyden
- Zilkha Neurogenetic Institute of the Keck School of Medicine at USC, Los Angeles, California, United States
| | - Michael D. Hill
- Department of Clinical Neuroscience & Hotchkiss Brain Institute, University of Calgary & Foothills Medical Centre, Calgary, Canada
| | - Bruce CV Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Kevin N Sheth
- Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, United States
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United Stated
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Massachusetts, United States
| | - Davide Carone
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher G. Favilla
- Department of Neurology, University of Pennsylvania Philadelphia, Pennsylvania, Unites States
| | | | - Gregory W. Albers
- Department of Neurology, Stanford University, Stanford, California, United States
| | - Jeremy J. Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, California, United States
| | - Maarten G Lansberg
- Department of Neurology, Stanford University, Stanford, California, United States
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Zeng W, Li W, Huang K, Lin Z, Dai H, He Z, Liu R, Zeng Z, Qin G, Chen W, Wu Y. Predicting futile recanalization, malignant cerebral edema, and cerebral herniation using intelligible ensemble machine learning following mechanical thrombectomy for acute ischemic stroke. Front Neurol 2022; 13:982783. [PMID: 36247767 PMCID: PMC9554641 DOI: 10.3389/fneur.2022.982783] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo establish an ensemble machine learning (ML) model for predicting the risk of futile recanalization, malignant cerebral edema (MCE), and cerebral herniation (CH) in patients with acute ischemic stroke (AIS) who underwent mechanical thrombectomy (MT) and recanalization.MethodsThis prospective study included 110 patients with premorbid mRS ≤ 2 who met the inclusion criteria. Futile recanalization was defined as a 90-day modified Rankin Scale score >2. Clinical and imaging data were used to construct five ML models that were fused into a logistic regression algorithm using the stacking method (LR-Stacking). We added the Shapley Additive Explanation method to display crucial factors and explain the decision process of models for each patient. Prediction performances were compared using area under the receiver operating characteristic curve (AUC), F1-score, and decision curve analysis (DCA).ResultsA total of 61 patients (55.5%) experienced futile recanalization, and 34 (30.9%) and 22 (20.0%) patients developed MCE and CH, respectively. In test set, the AUCs for the LR-Stacking model were 0.949, 0.885, and 0.904 for the three outcomes mentioned above. The F1-scores were 0.882, 0.895, and 0.909, respectively. The DCA showed that the LR-Stacking model provided more net benefits for predicting MCE and CH. The most important factors were the hypodensity volume and proportion in the corresponding vascular supply area.ConclusionUsing the ensemble ML model to analyze the clinical and imaging data of AIS patients with successful recanalization at admission and within 24 h after MT allowed for accurately predicting the risks of futile recanalization, MCE, and CH.
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Affiliation(s)
- Weixiong Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Kaibin Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhou Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Dai
- Hospital Office, Ganzhou People's Hospital, Ganzhou, China
- Hospital Office, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Zilong He
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Renyi Liu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaodong Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Genggeng Qin
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Genggeng Qin
| | - Weiguo Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Weiguo Chen
| | - Yongming Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Yongming Wu
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Yang Y, Cui T, Li Z, Li J, Duan T, Yuan Z, Wang C, Wan J, Li C, Zhang S, Li L, Hu F, Wu B. Benefits of Endovascular Treatment in Late Window for Acute Ischemic Stroke Selected without CT Perfusion: A Real-World Study. Clin Interv Aging 2022; 17:577-587. [PMID: 35497054 PMCID: PMC9041145 DOI: 10.2147/cia.s362119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023] Open
Abstract
Objective This study examined the functional outcomes and safety of endovascular treatment (EVT) in acute ischemic stroke (AIS) patients owing to large vessel occlusion of the anterior circulation, presented during a late-time window (6–24 hours after last seen well (LSW)) in a real-world practice. Methods This was a retrospective analysis from a bi-center prospective cohort. According to the stroke treatment, patients with continuous Alberta Stroke Plan Early Aspect score (ASPECTS) ≥6 on non-contrast CT (NCCT) and moderate to good collateral state on CT angiography (CTA) were divided into EVT group and standard medical treatment (SMT) group. The primary outcome was the rate of functional independence (90-day mRS ≤2). Safety outcomes were the occurrence of symptomatic intracranial hemorrhage (sICH) and the 90-day mortality. Results Among the 288 enrolled patients (53.5% male, median age 64 years), there were 167 patients in the EVT group and 121 in the SMT group. After multivariable adjustments for potential confounders, EVT was associated with functional independence (adjusted OR: 3.052; 95% confidence interval (CI): 1.553–5.997; p = 0.001). In the PSM cohort, 44.2% (42/95) of patients in the EVT group versus 18.9% (18/95) in the SMT group achieved functional independence (OR: 3.39, 95% CI: 1.763–6.517), and there was a significant difference favoring EVT over the SMT in the overall distribution of mRS (OR: 2.170, 95% CI: 1.302–3.618) at 90 days. The rate of sICH did not differ between the EVT and SMT groups (10.5% vs 8.4%, p = 0.804) nor did 90-day mortality (18.9% vs 22.1%, p = 0.719). No interaction was found in p-values with statistical significance in subgroup analysis. Conclusion This real-world experience suggests that EVT for late-presenting stroke patients, based on small core on NCCT and moderate to good collaterals on CTA, is associated with better outcomes than SMT alone, with no increase in sICH and 90-day mortality rates.
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Affiliation(s)
- Yuan Yang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Ting Cui
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zuoxiao Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Jinglun Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Ting Duan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Changyi Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jincheng Wan
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Cao Li
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Shujiang Zhang
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Ling Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Fayun Hu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Bo Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Correspondence: Bo Wu; Fayun Hu, Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China, Tel +86-18980602142; +86-15902861270, Email ;
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