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Title: Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis.
Austin Authors: Phan, Kevin;Saleh, Serag;Dmytriw, Adam A;Maingard, Julian;Barras, Christen;Hirsch, Joshua A;Kok, Hong Kuan;Brooks, Duncan Mark ;Chandra, Ronil V;Asadi, Hamed 
Affiliation: Department of Imaging, Monash University, Clayton, Victoria, Australia
Department of Radiology, Beaumont Hospital, Dublin, Ireland
NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
University of Adelaide, Adelaide, South Australia, Australia
NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
Interventional Neuroradiology Unit, Monash Health, Clayton, Victoria, Australia
Issue Date: Jul-2019 2018-11-10
Publication information: Journal of neurointerventional surgery 2019; 11(7): 664-669
Abstract: 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%; 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. 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.
DOI: 10.1136/neurintsurg-2018-014250
ORCID: 0000-0003-2475-9727
Journal: Journal of neurointerventional surgery
PubMed URL: 30415223
Type: Journal Article
Subjects: Stroke
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