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Noorian AR, Rangaraju S, Sun CH, et al. Endovascular Therapy in Strokes with ASPECTS 5-7 May Result in Smaller Infarcts and Better Outcomes as Compared to Medical Treatment Alone. Interv Neurol. 2015;4(1):30-7doi: 10.1159/000438775.
Noorian, A. R., Rangaraju, S., Sun, C. H., Owada, K., Nahab, F., Belagaje, S. R., Anderson, A. M., Frankel, M. R., & Nogueira, R. G. (2015). Endovascular Therapy in Strokes with ASPECTS 5-7 May Result in Smaller Infarcts and Better Outcomes as Compared to Medical Treatment Alone. Interventional neurology, 4(1), 30-7. https://doi.org/10.1159/000438775
Noorian, Ali Reza, et al. "Endovascular Therapy in Strokes with ASPECTS 5-7 May Result in Smaller Infarcts and Better Outcomes as Compared to Medical Treatment Alone." Interventional neurology vol. 4,1 (2015): 30-7. doi: https://doi.org/10.1159/000438775
Noorian AR, Rangaraju S, Sun CH, Owada K, Nahab F, Belagaje SR, Anderson AM, Frankel MR, Nogueira RG. Endovascular Therapy in Strokes with ASPECTS 5-7 May Result in Smaller Infarcts and Better Outcomes as Compared to Medical Treatment Alone. Interv Neurol. 2015 Oct;4(1):30-7. doi: 10.1159/000438775. Epub 2015 Sep 18. PMID: 26600794; PMCID: PMC4640089.
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Interv Neurol. 2015 Oct;4(1):30-7. doi: 10.1159/000438775. Epub 2015 Sep 18.

Endovascular Therapy in Strokes with ASPECTS 5-7 May Result in Smaller Infarcts and Better Outcomes as Compared to Medical Treatment Alone.

Interventional neurology

Ali Reza Noorian, Srikant Rangaraju, Chung-Huan Sun, Kumiko Owada, Fadi Nahab, Samir R Belagaje, Aaron M Anderson, Michael R Frankel, Raul G Nogueira

Affiliations

  1. Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga., USA.

PMID: 26600794 PMCID: PMC4640089 DOI: 10.1159/000438775

Abstract

INTRODUCTION: Intra-arterial therapy (IAT) for large vessel occlusion strokes (LVOS) has been increasingly utilized. The benefit of IAT in patients with midrange Alberta Stroke Program Early Computed Tomography Score (ASPECTS) remains to be established.

MATERIALS AND METHODS: This was a retrospective analysis of LVOS with ASPECTS 5-7 treated with IAT (n = 86) or medical therapy alone (intravenous tissue plasminogen activator; n = 15) at two centers from 2009 to 2012. Definitions were as follows: symptomatic intracranial hemorrhage = any parenchymal hematoma; successful reperfusion = mTICI ≥2b; good and acceptable outcomes = 90-day mRS 0-2 and 0-3, respectively. Final infarct volumes (FIV) were calculated based on 24-hour CT/MRI scans.

RESULTS: Mean age (67 ± 14 vs. 67 ± 19 years) and baseline NIHSS (20 ± 5 vs. 20 ± 6) were similar in the two groups. Successful reperfusion was achieved in 58 (67%) IAT patients. Symptomatic and asymptomatic intracranial hemorrhage occurred in 9 (10%) and 31 (36%) IAT patients, respectively. The proportion of 90-day good and acceptable outcomes was 20 (17/86) and 33% (28/86), respectively. Successful IAT reperfusion was associated with smaller FIV (p = 0.015) and higher rates of good (p = 0.01) and acceptable (p = 0.014) outcomes. There was a strong trend towards a higher hemicraniectomy requirement in medically as compared to endovascularly treated patients (20 vs. 6%; p = 0.06) despite similar in-hospital mortality. The median FIV was significantly lower with IAT versus medical therapy [80 ml (interquartile range, 38-122) vs. 190 ml (121-267); p = 0.015].

CONCLUSIONS: Despite a relatively low probability of achieving functional independence, IAT in LVOS patients with ASPECTS 5-7 appears to result in lower degrees of disability and may lessen the need for hemicraniectomy. Therefore, it may be a reasonable option for patients and families who favor a shift from severe to moderate disability.

Keywords: CT scan; Endovascular intervention; Stroke

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