Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• The efficacy of mechanical thrombectomy for acute ischemic stroke patients with low Alberta Stroke Program Early CT Score (ASPECTS 0-5) remains uncertain.
• Patients with severe infarct core (ASPECTS 0-5) often have poorer prognoses, posing treatment dilemmas.
• Understanding the impact of reperfusion on outcomes in this specific patient group is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the outcomes of patients with ASPECTS 0-5 treated with mechanical thrombectomy for anterior circulation large vessel occlusion.
• To assess the effect of successful reperfusion on clinical outcomes, including functional independence and mortality.
• To determine the safety profile, specifically the occurrence of symptomatic intracerebral hemorrhage, in this patient cohort.

Main Methods:

• A multicenter, pooled analysis of 7 prospective registries was conducted.
• Included were patients with anterior circulation large vessel occlusion and ASPECTS 0-5.
• Modified Rankin Scale (mRS) at 90 days was the primary outcome; functional independence (mRS 0-2), mortality, and symptomatic intracerebral hemorrhage were secondary outcomes. Multivariable logistic regression analyzed reperfusion's effect.

Main Results:

• Among 237 patients with ASPECTS 0-5, 40.1% achieved a favorable outcome (mRS 0-3) and 40.9% died at 90 days.
• Successful reperfusion was independently associated with favorable outcome (aOR, 5.534), functional independence (aOR, 5.583), reduced mortality (aOR, 0.180), and lower symptomatic intracerebral hemorrhage rates (aOR, 0.235).
• The mortality-reducing benefit of reperfusion persisted even in patients with ASPECTS 0-4 (aOR, 0.167).

Conclusions:

• Mechanical thrombectomy in patients with ASPECTS 0-5 is associated with beneficial outcomes when successful reperfusion is achieved.
• Successful reperfusion improves functional independence and reduces mortality without increasing symptomatic intracerebral hemorrhage risk.
• While not a definitive recommendation, these findings support the need for randomized controlled trials to formally test mechanical thrombectomy versus best medical treatment in this severe stroke population.