Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis
BackgroundPrompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inco...
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Published in | Journal of neurointerventional surgery Vol. 11; no. 7; pp. 664 - 669 |
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Abstract | BackgroundPrompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inconsistent in patient risk stratification and selection.ObjectiveTo conduct a meta-analysis to evaluate the available evidence for a clinically valid ASPECTS threshold in assessment of suitability for revascularization following AIS.MethodsTwo independent reviewers searched Medline (Ovid) and Cochrane Central Register of Systematic Reviews databases for studies appraising outcomes of endovascular thrombectomy (EVT) in relation to a variably-defined preoperative ASPECTS.ResultsA total of 13 articles were included. The pooled good outcome proportion after EVT was 41.4% (95% CI 36.4% to 46.6%; p<0.001), with subjective study-specific definitions of favorable and unfavorable subgroup outcomes of 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) and 33.2% (95% CI 28.5% to 38.3%; I2=33.16%), respectively. Objective trichotomization into low (0–4), intermediate (5–7), and high (8–10) subgroups yielded pooled good outcome proportions of 17.1% (95% CI 6.8% to 36.8%; I2=64.24%; p=0.039), 35.7% (95% CI 30.5% to 41.3%; I2=23.11%; p=0.245), and 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) for low, intermediate, and high ASPECTS, respectively.ConclusionsA subjectively favorable ASPECTS is associated with significantly better outcomes after EVT than an unfavorable ASPECTS, regardless of the cut-off used. EVT is unlikely to be useful in patients with an objectively low ASPECTS and is likely to be useful for those with high ASPECTS; findings in patients with intermediate ASPECTS were equivocal. |
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AbstractList | BACKGROUNDPrompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inconsistent in patient risk stratification and selection.OBJECTIVETo conduct a meta-analysis to evaluate the available evidence for a clinically valid ASPECTS threshold in assessment of suitability for revascularization following AIS.METHODSTwo independent reviewers searched Medline (Ovid) and Cochrane Central Register of Systematic Reviews databases for studies appraising outcomes of endovascular thrombectomy (EVT) in relation to a variably-defined preoperative ASPECTS.RESULTSA total of 13 articles were included. The pooled good outcome proportion after EVT was 41.4% (95% CI 36.4% to 46.6%; p<0.001), with subjective study-specific definitions of favorable and unfavorable subgroup outcomes of 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) and 33.2% (95% CI 28.5% to 38.3%; I2=33.16%), respectively. Objective trichotomization into low (0-4), intermediate (5-7), and high (8-10) subgroups yielded pooled good outcome proportions of 17.1% (95% CI 6.8% to 36.8%; I2=64.24%; p=0.039), 35.7% (95% CI 30.5% to 41.3%; I2=23.11%; p=0.245), and 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) for low, intermediate, and high ASPECTS, respectively.CONCLUSIONSA subjectively favorable ASPECTS is associated with significantly better outcomes after EVT than an unfavorable ASPECTS, regardless of the cut-off used. EVT is unlikely to be useful in patients with an objectively low ASPECTS and is likely to be useful for those with high ASPECTS; findings in patients with intermediate ASPECTS were equivocal. Prompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inconsistent in patient risk stratification and selection. To conduct a meta-analysis to evaluate the available evidence for a clinically valid ASPECTS threshold in assessment of suitability for revascularization following AIS. Two independent reviewers searched Medline (Ovid) and Cochrane Central Register of Systematic Reviews databases for studies appraising outcomes of endovascular thrombectomy (EVT) in relation to a variably-defined preoperative ASPECTS. A total of 13 articles were included. The pooled good outcome proportion after EVT was 41.4% (95% CI 36.4% to 46.6%; p<0.001), with subjective study-specific definitions of favorable and unfavorable subgroup outcomes of 49.7% (95% CI 44.2% to 55.3%; I =76.5%; p<0.001) and 33.2% (95% CI 28.5% to 38.3%; I =33.16%), respectively. Objective trichotomization into low (0-4), intermediate (5-7), and high (8-10) subgroups yielded pooled good outcome proportions of 17.1% (95% CI 6.8% to 36.8%; I =64.24%; p=0.039), 35.7% (95% CI 30.5% to 41.3%; I =23.11%; p=0.245), and 49.7% (95% CI 44.2% to 55.3%; I =76.5%; p<0.001) for low, intermediate, and high ASPECTS, respectively. A subjectively favorable ASPECTS is associated with significantly better outcomes after EVT than an unfavorable ASPECTS, regardless of the cut-off used. EVT is unlikely to be useful in patients with an objectively low ASPECTS and is likely to be useful for those with high ASPECTS; findings in patients with intermediate ASPECTS were equivocal. |
Author | Phan, Kevin Chandra, Ronil V Maingard, Julian Kok, Hong Kuan Saleh, Serag Brooks, Mark Hirsch, Joshua A Asadi, Hamed Barras, Christen Dmytriw, Adam A |
Author_xml | – sequence: 1 givenname: Kevin surname: Phan fullname: Phan, Kevin email: kphan.vc@gmail.com organization: NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia – sequence: 2 givenname: Serag surname: Saleh fullname: Saleh, Serag email: kphan.vc@gmail.com organization: NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia – sequence: 3 givenname: Adam A orcidid: 0000-0003-0131-5699 surname: Dmytriw fullname: Dmytriw, Adam A email: kphan.vc@gmail.com organization: Department of Medical Imaging, St Michael’s Hospital, Toronto, Ontario, Canada – sequence: 4 givenname: Julian surname: Maingard fullname: Maingard, Julian email: kphan.vc@gmail.com organization: Interventional Neuroradiology, Austin Health, Heidelberg, Victoria, Australia – sequence: 5 givenname: Christen surname: Barras fullname: Barras, Christen email: kphan.vc@gmail.com organization: University of Adelaide, Adelaide, South Australia, Australia – sequence: 6 givenname: Joshua A surname: Hirsch fullname: Hirsch, Joshua A email: kphan.vc@gmail.com organization: NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA – sequence: 7 givenname: Hong Kuan surname: Kok fullname: Kok, Hong Kuan email: kphan.vc@gmail.com organization: Department of Radiology, Beaumont Hospital, Dublin, Ireland – sequence: 8 givenname: Mark surname: Brooks fullname: Brooks, Mark email: kphan.vc@gmail.com organization: Interventional Neuroradiology, Austin Health, Heidelberg, Victoria, Australia – sequence: 9 givenname: Ronil V surname: Chandra fullname: Chandra, Ronil V email: kphan.vc@gmail.com organization: Department of Imaging, Monash University, Clayton, Victoria, Australia – sequence: 10 givenname: Hamed surname: Asadi fullname: Asadi, Hamed email: kphan.vc@gmail.com organization: Department of Radiology, Beaumont Hospital, Dublin, Ireland |
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Keywords | thrombolysis stroke thrombectomy |
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Snippet | BackgroundPrompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use... Prompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the... BACKGROUNDPrompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use... |
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SubjectTerms | Brain Ischemia - diagnosis Brain Ischemia - surgery Clinical trials Clinical Trials as Topic - methods Endovascular Procedures - methods Endovascular Procedures - trends Humans Medical imaging Meta-analysis Mortality Observational Studies as Topic Stroke Stroke - diagnosis Stroke - surgery Studies Systematic review Thrombectomy - methods Thrombectomy - trends |
Title | Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis |
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