Association between time to treatment and functional outcomes according to the Diffusion‐Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy

Abstract

Background and purposeThe rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion‐weighted magnetic resonance imaging (DWI‐MRI) and whether ischaemic core size affects this rate remain to be investigated.MethodsThis study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI‐MRI that was categorized into three groups: small [Diffusion‐Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS)] (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset‐to‐groin puncture time (OTP) and DWI‐ASPECTS categories regarding functional outcomes was investigated.ResultsUltimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI‐ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60‐min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15).ConclusionsOur study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI‐ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.

Futile reperfusion of endovascular treatment for acute anterior circulation large vessel occlusion in the ANGEL-ACT registry

“…We confirmed this and further found that, whether early or late presentation as compared with the mothership, anterior LVO patients with drip and ship were 1.56-fold more likely to experience futile reperfusion after EVT. The relationship could be explained by the higher baseline NIHSS and longer time from onset to puncture in drip and ship than the mothership, which were associated with poor outcomes after EVT 26 27. Therefore, LVO patients should be transferred to the comprehensive stroke center directly to receive EVT as soon as possible, which may reduce the time from onset to puncture to prevent futile reperfusion.…”

Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury

“…9 Nevertheless, the ASPECTS framework has consistently been utilized as a prognostic biomarker on CT and more recently on diffusion-weighted MRI. 29 Recent advancements in automated ASPECTS calculation on CT indicate that it may lead to improvements in accuracy and time efficiency over the original manual process. 30…”