Xiaochuan Huo MD, Thanh N Nguyen MD, Dapeng Sun MD, PhD, Raynald MD, Yuesong Pan PhD, Gaoting Ma MD, Xu Tong MD, Mengxing Wang PhD, Ning Ma MD, Feng Gao MD, Dapeng Mo MD, Mohamad Abdalkader MD, Hesham E. Masoud MD, Raul G. Nogueira MD, Zhongrong Miao MD, for the ANGEL-ASPECT study group
{"title":"Association of Mismatch Profiles and Clinical Outcome from Endovascular Therapy in Large Infarct: A Post-Hoc Analysis of the ANGEL-ASPECT Trial","authors":"Xiaochuan Huo MD, Thanh N Nguyen MD, Dapeng Sun MD, PhD, Raynald MD, Yuesong Pan PhD, Gaoting Ma MD, Xu Tong MD, Mengxing Wang PhD, Ning Ma MD, Feng Gao MD, Dapeng Mo MD, Mohamad Abdalkader MD, Hesham E. Masoud MD, Raul G. Nogueira MD, Zhongrong Miao MD, for the ANGEL-ASPECT study group","doi":"10.1002/ana.27017","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>We investigated whether patients with large infarct and the presence or absence of perfusion mismatch are associated with endovascular treatment benefit.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This is a post-hoc analysis of the Endovascular Therapy in Anterior Circulation Large Vessel Occlusion with a Large Infarct (ANGEL-ASPECT) randomized trial, which enrolled patients within 24 hours of onset with ASPECTS 3 to 5 or ASPECTS 0 to 2 with an infarct core 70 to 100 ml. Mismatch ratio was defined as time-to-maximum (T<sub>max</sub>) >6 s cerebral volume/ischemic core volume, and mismatch volume was defined as T<sub>max</sub> >6 s volume minus ischemic core volume. We divided patients into mismatch ratio ≥1.2 and mismatch volume ≥10 ml, and mismatch ratio ≥1.8 and mismatch volume ≥15 ml groups. The primary outcome was the 90-day modified Rankin Scale score ordinal distribution. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>There were 425 patients included. In both the mismatch ratio ≥1.2 and mismatch volume ≥10 ml (mismatch+, <i>n</i> = 395; mismatch−, <i>n</i> = 31) and mismatch ratio ≥1.8 and mismatch volume ≥15 ml groups (mismatch+, <i>n</i> = 346; mismatch−, <i>n</i> = 80), better 90-day modified Rankin Scale outcomes were found in the endovascular treatment group compared with the MM group (4 [2–5] vs 4 [3–5], common odds ratio [cOR], 1.9, 95% confidence interval [CI] 1.3–2.7, <i>p</i> = 0.001; 4 [2–5] vs 4 [3–5], cOR, 1.9, 95% CI 1.3–2.8, <i>p</i> = 0.001, respectively), but not in patients without mismatch ratio ≥1.2 and mismatch volume ≥10 ml (5 [3–6] vs 5 [4–6], cOR, 1.2, 95% CI 0.3–4.1, <i>p</i> = 0.83), and mismatch ratio ≥1.8 and mismatch volume ≥15 ml (4 [3–6] vs 5 [3–6], cOR, 1.2, 95% CI 0.6–2.7, <i>p</i> = 0.60). However, no interaction effect was found in both subgroups (<i>p</i> interaction >0.10).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Endovascular treatment was more efficacious than MM in patients with mismatch profiles, but no treatment effect or interaction was noted in the no mismatch profile patients. However, the small sample size of patients with no mismatch may have underpowered our analysis. A pooled analysis of large core trials stratified by mismatch is warranted. ANN NEUROL 2024;96:729–738</p>\n </section>\n </div>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":null,"pages":null},"PeriodicalIF":8.1000,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ana.27017","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives
We investigated whether patients with large infarct and the presence or absence of perfusion mismatch are associated with endovascular treatment benefit.
Methods
This is a post-hoc analysis of the Endovascular Therapy in Anterior Circulation Large Vessel Occlusion with a Large Infarct (ANGEL-ASPECT) randomized trial, which enrolled patients within 24 hours of onset with ASPECTS 3 to 5 or ASPECTS 0 to 2 with an infarct core 70 to 100 ml. Mismatch ratio was defined as time-to-maximum (Tmax) >6 s cerebral volume/ischemic core volume, and mismatch volume was defined as Tmax >6 s volume minus ischemic core volume. We divided patients into mismatch ratio ≥1.2 and mismatch volume ≥10 ml, and mismatch ratio ≥1.8 and mismatch volume ≥15 ml groups. The primary outcome was the 90-day modified Rankin Scale score ordinal distribution. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality.
Results
There were 425 patients included. In both the mismatch ratio ≥1.2 and mismatch volume ≥10 ml (mismatch+, n = 395; mismatch−, n = 31) and mismatch ratio ≥1.8 and mismatch volume ≥15 ml groups (mismatch+, n = 346; mismatch−, n = 80), better 90-day modified Rankin Scale outcomes were found in the endovascular treatment group compared with the MM group (4 [2–5] vs 4 [3–5], common odds ratio [cOR], 1.9, 95% confidence interval [CI] 1.3–2.7, p = 0.001; 4 [2–5] vs 4 [3–5], cOR, 1.9, 95% CI 1.3–2.8, p = 0.001, respectively), but not in patients without mismatch ratio ≥1.2 and mismatch volume ≥10 ml (5 [3–6] vs 5 [4–6], cOR, 1.2, 95% CI 0.3–4.1, p = 0.83), and mismatch ratio ≥1.8 and mismatch volume ≥15 ml (4 [3–6] vs 5 [3–6], cOR, 1.2, 95% CI 0.6–2.7, p = 0.60). However, no interaction effect was found in both subgroups (p interaction >0.10).
Conclusion
Endovascular treatment was more efficacious than MM in patients with mismatch profiles, but no treatment effect or interaction was noted in the no mismatch profile patients. However, the small sample size of patients with no mismatch may have underpowered our analysis. A pooled analysis of large core trials stratified by mismatch is warranted. ANN NEUROL 2024;96:729–738
期刊介绍:
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.