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. 2024 Jan 1;81(1):30-38.
doi: 10.1001/jamaneurol.2023.4430.

Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct: A Secondary Analysis of the ANGEL-ASPECT Trial

Dapeng Sun  1   2 , Xu Guo  3 , Thanh N Nguyen  4 , Yuesong Pan  1   2 , Gaoting Ma  5 , Xu Tong  1   2 , Raynald  1   2 , Mengxing Wang  2 , Ning Ma  1   2 , Feng Gao  1   2   4 , Dapeng Mo  1   2   4 , Xiaochuan Huo  3 , Zhongrong Miao  1   2 ; ANGEL-ASPECT Study Group
Collaborators, Affiliations

Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct: A Secondary Analysis of the ANGEL-ASPECT Trial

Dapeng Sun et al. JAMA Neurol. .

Abstract

Importance: Endovascular therapy (EVT) demonstrated better outcomes compared with medical management in recent randomized clinical trials (RCTs) of patients with large infarct.

Objective: To compare outcomes of EVT vs medical management across different strata of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and infarct core volume in patients with large infarct.

Design, setting, and participants: This prespecified secondary analysis of subgroups of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core (ANGEL-ASPECT) RCT included patients from 46 stroke centers across China between October 2, 2020, and May 18, 2022. Participants were enrolled within 24 hours of symptom onset and had ASPECTS of 3 to 5 or 0 to 2 and infarct core volume of 70 to 100 mL. Patients were divided into 3 groups: ASPECTS of 3 to 5 with infarct core volume less than 70 mL, ASPECTS of 3 to 5 with infarct core volume of 70 mL or greater, and ASPECTS of 0 to 2.

Interventions: Endovascular therapy or medical management.

Main outcomes and measures: The primary outcome was the ordinal 90-day modified Rankin Scale (mRS) score.

Results: There were 455 patients in the trial; median age was 68 years (IQR, 60-73 years), and 279 (61.3%) were male. The treatment effect did not vary significantly across the 3 baseline imaging subgroups (P = .95 for interaction). The generalized odds ratio for the shift in the 90-day mRS distribution toward better outcomes with EVT vs medical management was 1.40 (95% CI, 1.06-1.85; P = .01) in patients with ASPECTS of 3 to 5 and infarct core volume less than 70 mL, 1.22 (95% CI, 0.81-1.83; P = .23) in patients with ASPECTS of 3 to 5 and infarct core volume of 70 mL or greater, and 1.59 (95% CI, 0.89-2.86; P = .09) in patients with ASPECTS of 0 to 2.

Conclusions and relevance: In this study, no significant interaction was found between baseline imaging status and the benefit of EVT compared with medical management in patients with large infarct core volume. However, estimates within subgroups were underpowered. A pooled analysis of large core trials stratified by ASPECTS and infarct core volume strata is warranted.

Trial registration: ClinicalTrials.gov Identifier: NCT04551664.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Nguyen reported serving on the advisory board for Idorsia and Brainomix outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Patient Selection
ASPECTS indicates Alberta Stroke Program Early Computed Tomography Score; EVT, endovascular therapy; MM, medical management.
Figure 2.
Figure 2.. Modified Rankin Scale Score Distribution Stratified by Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and Infarct Core Volume
EVT indicates endovascular therapy; MM, medical management.
See this image and copyright information in PMC

References

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