Citations 1
Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows
Elawady, Sameh Samir , Uchida, Kazutaka , Maier, Ilko , Jabbour, Pascal , Kim, Joon‐Tae , Wolfe, Stacey Q , Rai, Ansaar , Starke, Robert M. , Psychogios, Marios‐Nikos , Grossberg, Jonathan A , Tanweer, Omar , Polifka, Adam , Crosa, Roberto , Park, Min S. , Brinjikji, Waleed , Moss, Mark, Dumont, Travis M., Williamson, Richard , Navía, Pedro , Kan, Peter , Chowdhry, Shakeel , Ezzeldin, Mohamad , Spiotta, Alejandro M , Crosa, Roberto , Wolfe, Stacey Quintero , Navia, Pedro , Cunningham, Conor M. , Matsukawa, Hidetoshi , Lin, Steven , Jabbour, Pascal , Samaniego, Edgar A , Arthur, Adam Stephen , Yoshimura, Shinichi , Cuellar, Hugo, Alawieh, Ali , Romano, Daniele G., Mascitelli, Justin R , Fragata, Isabel , Osbun, Joshua W , Matouk, Charles , Levitt, Michael R. , Leacy, Reade De , Kasab, Sami Al
Neurosurgery | May 17, 2024 | Volume: 95 | Issue: 4 | Pages: 877-885
BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.