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Observational Study
. 2021 Jul;52(7):2220-2228.
doi: 10.1161/STROKEAHA.120.032430. Epub 2021 Jun 3.

Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry

Osama O Zaidat  1 , David S Liebeskind  2 , Ashutosh P Jadhav  3 , Santiago Ortega-Gutierrez  4 , Thanh N Nguyen  5 , Diogo C Haussen  6 , Dileep R Yavagal  7 , Michael T Froehler  8 , Reza Jahan  9 , Raul G Nogueira  6 , Tom L Yao  10 , Bader A Alenzi  11 , Saif Bushnaq  1 , Nils H Mueller-Kronast  12
Affiliations
Observational Study

Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry

Osama O Zaidat et al. Stroke. 2021 Jul.

Abstract

Background and purpose: This study investigates clinical outcomes after mechanical thrombectomy in adult patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) of 0 to 5.

Methods: We included data from the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) from patients who underwent mechanical thrombectomy within 8 hours of symptom onset and had available ASPECTS data adjudicated by an independent core laboratory. Angiographic and clinical outcomes were collected, including successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), functional independence (modified Rankin Scale score 0-2), 90-day mortality, and symptomatic intracranial hemorrhage at 24 hours. Outcomes were stratified by ASPECTS scores and age.

Results: Of the 984 patients enrolled, 763 had available ASPECTS data. Of these patients, 57 had ASPECTS of 0 to 5 with a median age of 63 years (interquartile range, 28-100), whereas 706 patients had ASPECTS of 6 to 10 with a median age of 70 years of age (interquartile range, 19-100). Ten patients had ASPECTS of 0 to 3 and 47 patients had ASPECTS of 4 to 5 at baseline. Successful reperfusion was achieved in 85.5% (47/55) in the ASPECTS of 0 to 5 group. Functional independence was achieved in 28.8% (15/52) in the ASPECTS of 0 to 5 versus 59.7% (388/650) in the 6 to 10 group (P<0.001). Mortality rates were 30.8% (16/52) in the ASPECTS of 0 to 5 and 13.4% (87/650) in the 6 to 10 group (P<0.001). sICH rates were 7.0% (4/57) in the ASPECTS of 0 to 5 and 0.9% (6/682) in the 6 to 10 group (P<0.001). No patients aged >75 years with ASPECTS of 0 to 5 (0/12) achieved functional independence versus 44.8% (13/29) of those age ≤65 (P=0.005).

Conclusions: Patients <65 years of age with large core infarction (ASPECTS 0-5) have better rates of functional independence and lower rates of mortality compared with patients >75 years of age. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239640.

Keywords: age; cerebral infarction; intracranial hemorrhage; ischemic stroke; large core infarction; thrombectomy.

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Figures

Figure 1.
Figure 1.
Low Alberta Stroke Program Early CT Score (ASPECTS) study flow chart.
Figure 2.
Figure 2.
Functional outcome (modified Rankin Scale [mRS]) at 90 d in patients with Alberta Stroke Program Early CT Score (ASPECTS) of 6–10, 4–5, and 0–3 (A). Functional independence (mRS score 0-2) at 90 d by ASPECTS score. Number of patients corresponding to each ASPECTS is listed above the baseline (B).
See this image and copyright information in PMC

Comment in

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