Clinical Severity and Outcomes in Large Infarcts With Endovascular Therapy: A Post Hoc Analysis of the ANGEL-ASPECT Trial.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-04-01 Epub Date: 2025-02-27 DOI:10.1161/STROKEAHA.124.049315

Qixuan Lu, Lina Zheng, Ximing Nie, Mengxing Wang, Wanying Duan, Xin Liu, Zhe Zhang, Miao Wen, Zhonghua Yang, Xinyi Leng, Yuesong Pan, Thanh N Nguyen, Liping Liu

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引用次数: 0

Abstract

Background: Endovascular therapy (EVT) has been proven effective for patients with acute ischemic stroke with large infarcts. This study aimed to explore the impact of clinical severity on the efficacy of EVT in such patients.

Methods: This was a post hoc analysis of the ANGEL-ASPECT trial (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core), a randomized controlled trial that enrolled patients from 46 centers across China between October 2, 2020, and May 18, 2022. These patients had large infarcts (defined as Alberta Stroke Program Early CT Score of 3-5 or infarct-core volume 70-100 mL) due to anterior-circulation large vessel occlusion within 24 hours after stroke onset with a National Institutes of Health Stroke Scale score of 6 to 30. Patients were randomized into either the EVT group or the medical management alone (MM) group. For this analysis, we categorized the patients into 2 subgroups: moderate stroke and severe stroke, based on a baseline National Institutes of Health Stroke Scale score of either <20 or ≥20. The primary outcome was the ordinal 90-day modified Rankin Scale score (0, no symptoms, to 6, death).

Results: Among 455 eligible patients, 347 (76.3%) presented with moderate stroke (170 received EVT, 177 underwent MM), and 108 (23.7%) had severe stroke (60 received EVT, 48 underwent MM). A significant shift toward better outcomes in the 90-day modified Rankin Scale distribution was observed in the EVT group compared with the MM group (generalized odds ratio, 1.66 [95% CI, 1.29-2.13]; P<0.001) among patients with moderate stroke. However, this was not the case for those with severe stroke (generalized odds ratio, 1.06 [95% CI, 0.54-2.10]; P=0.87), indicating a significant interaction (P=0.03).

Conclusions: In patients with acute large infarcts, EVT was associated with improved functional outcomes compared with MM in patients with moderate stroke. However, no significant difference was observed in patients with severe stroke. Therefore, stroke severity should be considered when selecting patients with large infarcts for EVT.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04551664.

查看原文本刊更多论文

血管内治疗的大面积梗死的临床严重程度和结果：ANGEL-ASPECT试验的事后分析。

背景：血管内治疗（EVT）已被证明对急性缺血性脑卒中合并大面积梗死患者有效。本研究旨在探讨临床严重程度对此类患者EVT疗效的影响。方法：这是对ANGEL-ASPECT试验（血管内治疗急性前循环大血管闭塞伴大梗死核心患者）的事后分析，该试验是一项随机对照试验，在2020年10月2日至2022年5月18日期间招募了来自中国46个中心的患者。这些患者在卒中发作后24小时内由于前循环大血管闭塞发生大面积梗死（定义为Alberta卒中计划早期CT评分为3-5或梗死核容量为70-100 mL），美国国立卫生研究院卒中量表评分为6 - 30。患者被随机分为EVT组或单独医疗管理（MM）组。在这项分析中，我们根据美国国立卫生研究院卒中量表的基线评分将患者分为2个亚组：中度卒中和重度卒中。结果：在455例符合条件的患者中，347例（76.3%）为中度卒中（170例接受EVT， 177例接受MM）， 108例（23.7%）为重度卒中（60例接受EVT， 48例接受MM）。与MM组相比，EVT组在90天的改良兰金量表分布中有显著的改善(广义优势比，1.66 [95% CI, 1.29-2.13]；PP=0.87)，表明交互作用显著（P=0.03）。结论：在急性大面积梗死患者中，与中度卒中患者的MM相比，EVT与改善的功能预后相关。然而，在严重脑卒中患者中没有观察到显著差异。因此，在选择大面积梗死患者进行EVT时应考虑脑卒中严重程度。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT04551664。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.