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- Title
Endovascular Therapy and Outcomes Among Patients With Very Large Ischemic Core Stroke.
- Authors
Xie, Dongjing; Huang, Jiacheng; Fan, Shitao; Guo, Changwei; Sun, Wenzhe; Peng, Zhouzhou; Zhang, Lingyu; Yue, Chengsong; Qiu, Zhongming; Sang, Hongfei; Liang, Dingwen; Hu, Jinrong; Yang, Jie; Huang, Jiandi; Li, Linyu; Liu, Juan; Yang, Dahong; Liu, Xiang; Kong, Weilin; Liu, Shuai
- Abstract
Key Points: Question: What is the association of endovascular therapy (EVT) vs standard medical treatment with outcomes in patients with very large ischemic core stroke? Findings: In this cohort study of 245 patients with Alberta Stroke Program Early Computed Tomography Score of 0 to 2 based on noncontrast computed tomography findings within 24 hours of stroke onset, EVT was associated with higher proportion of favorable functional outcome at 90 days compared with standard medical treatment alone. Meaning: These findings suggest that EVT should be considered a useful strategy for treatment of patients with very large ischemic core. This cohort study explores outcomes associated with endovascular therapy vs standard medical treatment alone for patients with very large ischemic core stroke, as assessed with noncontrast computed tomography. Importance: The association of endovascular therapy (EVT) with outcomes is unclear for patients with very low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) within 24 hours of stroke onset. Objective: To explore the association of EVT with functional and safety outcomes among patients with ASPECTS of 0 to 2 scored with noncontrast computed tomography. Design, Setting, and Participants: This cohort study used data from an ongoing, prospective, observational, nationwide registry including all patients treated at 38 stroke centers in China with an occlusion in the internal carotid artery or M1 or M2 segment of the middle cerebral artery within 24 hours of witnessed symptom onset. Patients with ASPECTS of 0 to 2 between November 1, 2021, and February 8, 2023, were included in analysis. Data were analyzed October to November 2023. Exposures: EVT vs standard medical treatment (SMT). Main Outcomes and Measures: The primary outcome was favorable functional outcome, defined as modified Rankin Scale score (mRS) of 0 to 3, at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH) within 48 hours and mortality at 90 days. Results: A total of 245 patients (median [IQR] age, 71 [63-78] years; 118 [48%] women) with ASPECTS of 0 to 2 were included, of whom 111 patients (45.1%) received SMT and 135 patients (54.9%) received EVT. The EVT group had significantly greater odds of favorable functional outcome at 90 days than the SMT group (30 patients [22.2%] vs 11 patients [9.9%]; P =.01; adjusted odds ratio [aOR], 3.07 [95% CI, 1.29-7.31]; P =.01). Patients in the EVT group, compared with the SMT group, had significantly greater odds of any ICH (56 patients [41.5%] vs 16 patients [11.4%]; P <.001; aOR, 4.27 [95% CI, 2.19-8.35]; P <.001) and sICH (24 patients [17.8%] vs 1 patient [0.9%]; P <.001; aOR, 23.07 [95% CI, 2.99-177.79]; P =.003) within 48 hours. There were no differences between groups for 90-day mortality (80 patients [59.3%] vs 59 patients [53.2%]; P =.34; aOR, 1.38 [95% CI, 0.77-2.47]; P =.28). The results remained robust in the propensity score–matched analysis. Conclusions and Relevance: In this cohort study of patients with very low ASPECTS based on NCCT within 24 hours of stroke onset, those treated with EVT had higher odds of a favorable functional outcome compared with those who received SMT. Randomized clinical trials are needed to assess these findings.
- Subjects
CHINA; PATIENT safety; SURGERY; PATIENTS; DATA analysis; RESEARCH funding; COMPUTED tomography; FUNCTIONAL assessment; SCIENTIFIC observation; FISHER exact test; MULTIPLE regression analysis; CEREBRAL arterial diseases; HYPERTENSION; ENDOVASCULAR surgery; TREATMENT effectiveness; DESCRIPTIVE statistics; MANN Whitney U Test; CHI-squared test; MULTIVARIATE analysis; LONGITUDINAL method; ODDS ratio; ISCHEMIC stroke; STATISTICS; INTRACRANIAL arterial diseases; COMPARATIVE studies; DATA analysis software; CONFIDENCE intervals; DIABETES
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe249298
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.9298