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Thrombectomy With Low ASPECTS: The Roles of Infarct Volume and Postacute Neurological Status.

Helge C Kniep1, Susanne Gellißen1, Götz Thomalla2

  • 1Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention (H.C.K., S.G., L.W., G.B., M. Bechstein, F.F., J.F., L.M.), Universitätsklinikum Hamburg-Eppendorf, Germany.

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|March 25, 2025
PubMed
Summary
This summary is machine-generated.

Endovascular thrombectomy significantly improves outcomes in low Alberta Stroke Program Early CT Score patients. Early neurological status, not infarct volume, better predicts functional outcomes after stroke treatment.

Keywords:
braininfarctionischemiastrokethrombectomy

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Clinical Trials

Background:

  • Randomized trials show endovascular therapy benefits patients with low Alberta Stroke Program Early CT Score (ASPECTS).
  • Large infarct volumes in these patients challenge infarct size as a sole predictor of functional outcomes.
  • This analysis investigates the role of infarct volume and early neurological status in explaining endovascular thrombectomy's effect.

Purpose of the Study:

  • To determine the extent to which follow-up infarct volume and early neurological status explain the functional outcome benefits of endovascular thrombectomy in low ASPECTS stroke patients.
  • To evaluate the predictive power of infarct volume versus early neurological status for functional outcomes.

Main Methods:

  • Secondary analysis of the TENSION randomized trial (n=188) including patients with anterior circulation large vessel occlusion and ASPECTS 3-5.
  • Confounder-adjusted mediation analysis was used to quantify the proportion of treatment effect on 90-day modified Rankin Scale (mRS) score explained by 24-hour infarct volume and 24-hour National Institutes of Health Stroke Scale (NIHSS) scores.
  • Patients received either endovascular thrombectomy plus medical treatment or medical treatment alone.

Main Results:

  • Endovascular thrombectomy increased the probability of independent ambulation (mRS 0-3) by 20.5 percentage points and reduced 90-day mortality by 24.2 percentage points compared to medical treatment alone.
  • A reduction in 24-hour infarct volume explained 30% of the treatment effect on functional outcomes.
  • The 24-hour NIHSS score explained 61% of the treatment effect on functional outcomes.

Conclusions:

  • Early neurological status (NIHSS) is a stronger predictor of functional outcomes than infarct volume in low ASPECTS stroke patients treated with endovascular thrombectomy.
  • Neurological status may better capture factors like brain region involvement and network disruption influencing recovery.
  • These findings refine our understanding of stroke outcome predictors and treatment efficacy in specific patient populations.