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RESCUE study: Association between ASPECT scores and the effectiveness and safety of endovascular therapy in stroke patients with large-vessel occlusion

 Last Update: 2022-10-25
 Source: Internet
 Author: User

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Endovascular therapy (EVT) has been found to reduce dysfunction in patients with acute stroke due to large vessel occlusion
.
However, the range of ischemic zones measured using ASPECT scores may limit the efficacy
of EVT.
The study aimed to compare the efficacy and safety
of EVT according to ASPECTS ≤3 with 4-5.

RESCUE-Japan LIMIT is an open-label, randomized clinical trial conducted
at 45 stroke centers across Japan from November 2018 to December 2021.
The trial enrolled adult patients with acute ischemic stroke with a large ischemic area, defined primarily as aspects 3-5 as determined by MRI, with occlusion in the internal carotid artery or M1 segment
.
Patients were randomly assigned to EVT versus medical treatment or medical treatment alone, and the primary outcomes and measures were mRS score at 90 days and symptomatic and any intracranial hemorrhage
within 48 hours.

Results showed that of 202 patients, 106 (52%) ASPECTS≤3 (mean [SD] age, 76.
7 [9.
6] years; 54 women [50.
9%]), 96 ASPECTS 4-5 (mean [SD] age, 75.
6 [10.
6] years; 36 women [37.
5%]).

Among patients with ASPECTS≤ 3, 12 (21.
4%) in the EVT group and 9 (18.
0%) in the EVT-free group had mRS scores of 0-3 (OR=1.
24; 95% CI, 0.
47-3.
26).

Among ASPECTS 4-5 patients, 19 patients (43.
2%) in the EVT group and 4 patients (7.
7%) in the EVT-free group had mRS scores of 0-3 at 90 days (OR=9.
12; 95% CI, 2.
80-29.
70; interaction P = .
01).

The sequential shift in mRS scores towards better outcomes was not evident in patients with ASPECTS≤3 (common OR = .
56; 95% CI, 0.
79 to 3.
10), but was evident in patients with aspects 4 to 5 (common OR=4.
48; 95% CI, 2.
07-9.
71; interaction P=.
046).

ASPECTS ≤3 HAD A SIGNIFICANTLY INCREASED RISK OF INTRACRANIAL HAEMORRHAGE (OR=4.
14; 95% CI, 1.
84-9.
32) WHEN PERFORMING EVT BUT NOT SIGNIFICANTLY IN PATIENTS WITH ASPECTS 4-5 (OR=2.
05; 95% CI, 0.
89-4.
73; INTERACTION P = .
24).

In summary, in this study, EVT was associated
with 90-day functional improvement in patients with acute large-vessel occlusive stroke with an ASPECTS of 4-5 patients.

References:

Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion: A Secondary Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism—Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT).
JAMA Neurol.
Published online October 10, 2022.
doi:10.
1001/jamaneurol.
2022.
3285

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