Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT.

IF 6 1区医学 Q1 CLINICAL NEUROLOGY

Journal of Stroke Pub Date : 2023-09-01 Epub Date: 2023-09-26 DOI:10.5853/jos.2023.01641

Fumihiro Sakakibara, Kazutaka Uchida, Shinichi Yoshimura, Nobuyuki Sakai, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kazumi Kimura, Reiichi Ishikura, Manabu Inoue, Kumiko Ando, Atsushi Yoshida, Kanta Tanaka, Takeshi Yoshimoto, Junpei Koge, Mikiya Beppu, Manabu Shirakawa, Takeshi Morimoto

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引用次数: 0

Abstract

Background and purpose: Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core.

Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan-Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3-5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum.

Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65-2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46-16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008).

Conclusion: Patients with ASPECTS of 3-5 on MRI benefitted more from EVT than those with ASPECTS of 3-5 on CT.

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大面积缺血性核心的影像学研究模式和血管内治疗：来自RESCUE日本极限的见解。

背景和目的：使用阿尔伯塔省卒中项目早期计算机断层扫描评分（ASPECTS）通过非对比计算机断层扫描（CT-ASPECTS层）和扩散加权成像（DWI-ASPECTS层）测量急性缺血性卒中程度的差异可能会影响血管内治疗（EVT）对大缺血核心患者的疗效。方法：RESCUE Japan LIMIT（通过血管内抢救恢复大脑超急性栓塞日本大型IscheMIc核心试验）是一项多中心、开放标签、随机临床试验，评估EVT对3-5岁ASPECTS患者的疗效和安全性。当测量CT-ASPECTS和DWI-ASPECTS时，优先考虑CT-ASPECT。EVT在90天时对每个阶层的改良兰金量表（mRS）评分的影响分别进行评估。结果：183例患者中，112例（EVT组，53例；无EVT组（59例））位于CT-ASPECTS层，71例（EVT组，40例；无EV组，31例）位于DWI-ASPECTS层。与CT-ASPECTS层中的无EVT组相比，EVT组的mRS评分向0的一个量表偏移的共同优势比（OR）（95%置信区间）为1.29（0.65-2.54），DWI-ASPECTS评分为6.15（2.46-16.3），治疗分配和影像学研究模式之间存在显著的相互作用（P=0.002）。在48小时时美国国立卫生研究院卒中量表评分的改善（CT-ASPECTS评分：OR，1.95；DWIASPECTS分别：OR，14.5；相互作用P=0.035）和90天时的死亡率方面存在显著的交互作用（CT-ASPECTS分级：OR，2.07；DWI-ASPECTS分级：OR为0.23；交互作用P=0.008）。

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来源期刊

Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE

CiteScore

11.00

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.