Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows

Sameh Samir Elawady; Conor Cunningham; Hidetoshi Matsukawa; Kazutaka Uchida; Steven Lin; Ilko Maier; Pascal Jabbour; Joon-Tae Kim; Stacey Quintero Wolfe; Ansaar Rai; Robert M Starke; Marios-Nikos Psychogios; Edgar A Samaniego; Adam Arthur; Shinichi Yoshimura; Hugo Cuellar; Jonathan A Grossberg; Ali Alawieh; Daniele G Romano; Omar Tanweer; Justin Mascitelli; Isabel Fragata; Adam Polifka; Joshua Osbun; Roberto Crosa; Charles Matouk; Min S Park; Michael R Levitt; Waleed Brinjikji; Mark Moss; Travis Dumont; Richard Williamson Jr; Pedro Navia; Peter Kan; Reade De Leacy; Shakeel Chowdhry; Mohamad Ezzeldin; Alejandro M Spiotta; Sami Al Kasab

doi:10.1227/neu.0000000000002992

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Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows

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Peer reviewed

Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows

Sameh Samir Elawady, Conor Cunningham, Hidetoshi Matsukawa, Kazutaka Uchida, Steven Lin, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, …

Neurosurgery, Vol.95(4), pp.877-885

05/17/2024

DOI: 10.1227/neu.0000000000002992

PMID: 38758725

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https://resolver.sub.uni-goettingen.de/purl?gro-2/143599View

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Abstract

This study aimed to compare outcomes of low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients with stroke who underwent mechanical thrombectomy (MT) within 6 hours or 6 to 24 hours after stroke onset. A retrospective cohort study was conducted using data from a large multicenter international registry from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent MT for anterior circulation intracranial large vessel occlusion were included. A propensity matching analysis was conducted for patients presented in the early (<6 hours) vs late (6-24 hours) time window after symptom onset or last known normal. Among the 10 229 patients who underwent MT, 274 met the inclusion criteria. 122 (44.5%) patients were treated in the late window. Early window patients were older (median age, 74 years [IQR, 63-80] vs 66.5 years [IQR, 54-77]; P < .001), had lower proportion of female patients (40.1% vs 54.1%; P = .029), higher median admission National Institutes of Health Stroke Scale score (20 [IQR, 16-24] vs 19 [IQR, 14-22]; P = .004), and a higher prevalence of atrial fibrillation (46.1% vs 27.3; P = .002). Propensity matching yielded a well-matched cohort of 84 patients in each group. Comparing the matched cohorts showed there was no significant difference in acceptable outcomes at 90 days between the 2 groups (odds ratio = 0.90 [95% CI = 0.47-1.71]; P = .70). However, the rate of symptomatic ICH was significantly higher in the early window group compared with the late window group (odds ratio = 2.44 [95% CI = 1.06-6.02]; P = .04). Among patients with anterior circulation large vessel occlusion and low ASPECTS, MT seems to provide a similar benefit to functional outcome for patients presenting <6 hours or 6 to 24 hours after onset.

Acute ischemic stroke

ASPECTS

Late window

Mechanical thrombectomy

Details

Title: Subtitle: Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows
Creators: Sameh Samir Elawady - Medical University of South Carolina
Conor Cunningham - Medical University of South Carolina
Hidetoshi Matsukawa - Medical University of South Carolina
Kazutaka Uchida - Medical University of South Carolina
Steven Lin - Medical University of South Carolina
Ilko Maier - Universitätsmedizin Göttingen
Pascal Jabbour - Jefferson University Hospitals
Joon-Tae Kim - Chonnam National University Hospital
Stacey Quintero Wolfe - Wake Forest University
Ansaar Rai - West Virginia University
Robert M Starke - University of Miami Health System
Marios-Nikos Psychogios - University of Basel
Edgar A Samaniego - University of Iowa
Adam Arthur - University of Tennessee Health Science Center
Shinichi Yoshimura - Hyogo University
Hugo Cuellar - Louisiana State University in Shreveport
Jonathan A Grossberg - Emory University
Ali Alawieh - Emory University
Daniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona
Omar Tanweer - Baylor College of Medicine
Justin Mascitelli - The University of Texas Health Science Center at San Antonio
Isabel Fragata - Hospital de São José
Adam Polifka - University of Florida
Joshua Osbun - Washington University in St. Louis
Roberto Crosa - Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay
Charles Matouk - Yale University
Min S Park - University of Virginia
Michael R Levitt - University of Washington
Waleed Brinjikji - Mayo Clinic
Mark Moss - Washington Regional Medical Center
Travis Dumont - University of Arizona
Richard Williamson Jr - Allegheny Health Network
Pedro Navia - Hospital Universitario La Paz
Peter Kan - The University of Texas Medical Branch at Galveston
Reade De Leacy - Mount Sinai Health System
Shakeel Chowdhry - NorthShore University HealthSystem
Mohamad Ezzeldin - University of Houston
Alejandro M Spiotta - Medical University of South Carolina
Sami Al Kasab - Medical University of South Carolina
Resource Type: Journal article
Publication Details: Neurosurgery, Vol.95(4), pp.877-885
DOI: 10.1227/neu.0000000000002992
PMID: 38758725
NLM abbreviation: Neurosurgery
ISSN: 0148-396X
eISSN: 1524-4040
Publisher: LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
Grant note: Stryker
Language: English
Electronic publication date: 05/17/2024
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984628050602771

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