Published in:Journal of NeuroInterventional Surgery
Language:
English
DOI:
10.1136/neurintsurg-2019-015308
ISSN:
1759-8478;
1759-8486
Origination:
Footnote:
Description:
<jats:sec><jats:title>Background</jats:title><jats:p>Benefit of thrombectomy in patients with a low initial Alberta Stroke Program Early CT Score (ASPECTS) is still uncertain. We hypothesized that, despite low ASPECTS, patients may benefit from endovascular recanalization if good collaterals are present.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Ischemic stroke patients with large vessel occlusion in the anterior circulation and an ASPECTS of ≤5 were analyzed. Collateral status (CS) was assessed using a 5-point-scoring system in CT angiography with poor CS defined as CS=0–1. Clinical outcome was determined using the modified Rankin Scale (mRS) score after 90 days. Edema formation was measured in admission and follow-up CT by net water uptake.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>27/100 (27%) patients exhibited a CS of 2–4. 50 patients underwent successful vessel recanalization and 50 patients had a persistent vessel occlusion. In multivariable logistic regression analysis, collateral status (OR 3.0; p=0.003) and vessel recanalization (OR 12.2; p=0.009) significantly increased the likelihood of a good outcome (mRS 0–3). A 1-point increase in CS was associated with 1.9% (95% CI 0.2% to 3.7%) lowered lesion water uptake in follow-up CT .</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Endovascular recanalization in patients with ASPECTS of ≤5 but good collaterals was linked to improved clinical outcome and attenuated edema formation. Collateral status may serve as selection criterion for thrombectomy in low ASPECTS patients.</jats:p></jats:sec>