Abstract
Background
The Alberta Stroke Program Early CT scan Score (ASPECTS) is a reliable imaging biomarker of infarct extent on admission but the value of 24-hour ASPECTS evolution in day-to-day practice is not well studied, especially after successful reperfusion. We aimed to assess the association between ASPECTS evolution after successful reperfusion with functional and safety outcomes, as well as to identify the predictors of ASPECTS evolution.
Methods
We used data from an ongoing prospective multicenter registry. Stroke patients with anterior circulation large vessel occlusion treated with endovascular therapy (EVT) and achieved successful reperfusion (modified thrombolysis in cerebral ischemia (mTICI) 2b-3) were included. ASPECTS evolution was defined as one or more point decrease in ASPECTS at 24 hours.
Results
A total of 2366 patients were enrolled. In a fully adjusted model, ASPECTS evolution was associated with lower odds of favorable outcome (modified Rankin Scale (mRS) score 0-2) at 90 days (adjusted odds ratio (aOR) = 0.46; 95% confidence interval (CI) = 0.37–0.57). In addition, ASPECTS evolution was a predictor of excellent outcome (90-day mRS 0-1) (aOR = 0.52; 95% CI = 0.49–0.57), early neurological improvement (aOR = 0.42; 95% CI = 0.35–0.51), and parenchymal hemorrhage (aOR = 2.64; 95% CI, 2.03–3.44). Stroke severity, admission ASPECTS, total number of passes, complete reperfusion (mTICI 3 vs. mTICI 2b-2c) and good collaterals emerged as predictors of ASPECTS evolution.
Conclusion
ASPECTS evolution is a strong predictor of functional and safety outcomes after successful endovascular therapy. Higher number of EVT attempts and incomplete reperfusion are associated with ASPECTS evolution at day 1.
Keywords: ASPECTS, stroke, thrombectomy, outcome
Introduction
Endovascular therapy (EVT) has revolutionized the acute treatment of ischemic stroke. 1 Preprocedural imaging is essential for patient selection for EVT. The Alberta Stroke Early Program CT Scan score (ASPECTS) is a well validated and widely used tool that has been shown to predict outcome after EVT.2–4 However, the importance of 24-hour ASPECTS and ASPECTS change has not been well studied. Post hoc analysis of the SWIFT (Solitaire Flow Restoration with the Intention for Thrombectomy) and DAWN (diffusion-weighted imaging (DWI) or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) trials demonstrated a strong association between ASPECTS evolution and functional outcome after EVT.5,6 The previous studies were limited by small sample size. Moreover, the previous studies were post hoc analysis of randomized trials and were not validated in real-world practice.
We undertook this study to further validate previous studies’ findings using data from the ongoing prospective multicenter registry. Moreover, unlike previous studies, we focused in this study on the subgroup of patients who achieved successful reperfusion to assess the impact of ASPECTS evolution on functional and safety outcomes after successful EVT.
Methods
Cohort
This is a retrospective analysis of an ongoing French registry that is enrolling patients with acute ischemic stroke due to large vessel occlusions treated with EVT at 18 comprehensive stroke centers in France. For the purpose of this study, we enrolled patients if they met the following criteria: (1) intracranial proximal anterior circulation large vessel occlusion (i.e. intracranial internal carotid artery, M1 or M2 segment of middle cerebral artery); (2) achieved successful reperfusion at the end of procedure; and (3) had ASPECTS documented on admission and at 24 hours. There was no exclusion based on stroke severity or time from onset to reperfusion. ASPECTS was scored either on computed tomography (CT) or magnetic resonance imaging (MRI) on admission and at 24 hours. ASPECTS was scored by experienced neuroradiologists blinded to clinical outcomes at each center. ASPECTS evolution was defined as one or more point decrease in ASPECTS at 24 hours. Local Institutional Review Boards approved data collection and analyses.
ASPECTS
ASPECTS score on the pretreatment MRI or CT was evaluated prospectively by experienced neuroradiologist blinded to the results of the endovascular procedure and clinical outcomes. ASPECTS region was scored 0 if abnormal and 1 if normal. To be considered as abnormal, the DWI hyperintense or CT hypodense signal had to be confluent. Arterial occlusion site and status were monitored with conventional angiography during the endovascular procedure.
Variables definitions
Reperfusion status was assessed using modified thrombolysis in cerebral ischemia (mTICI) and successful reperfusion was defined as mTICI 2b-3. Complete reperfusion was defined as mTICI 3. Admission stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS). Clot burden score was assessed on admission MR or CT angiogram as described before. 7 Collateral status was assessed on pretreatment angiogram according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology guidelines as described before.8,9 Functional outcome was assessed using modified Rankin scale (mRS). Approximately 90 days after the acute event, functional outcome was assessed by board-certified vascular neurologists during a routinely scheduled clinical visit or by a study nurse certified in administering the mRS during a standardized telephone interview if the patient was unable to attend.
Outcomes
The primary outcome is favorable functional outcome at 90 days, defined as mRS 0-2. Secondary outcomes include excellent outcome (90-day mRS 0-1) and early neurological improvement (decrease of 8 or more points in NIHSS at 24 hours). Safety outcomes include hemorrhagic complications and 90-day all-cause mortality. Hemorrhagic complications include parenchymal hemorrhage and symptomatic intracerebral hemorrhage, which were scored according to the ECASS criteria.10,11
Statistical analysis
Continuous variables are expressed as means SD or medians (interquartile range), and categorical variables as number (percentage). Normality of distribution was assessed using histograms and the Shapiro-Wilk test. Bivariate comparisons for baseline, treatment characteristics, and outcomes between the study groups were made using the χ2 test for categorical variables, and the Mann–Whitney U test for non-Gaussian continuous and ordinal categorical variables, as appropriate.
Differences in outcomes (early neurological improvement, mRS 0-2, mRS 0-1, mRS 6, parenchymal hemorrhage, symptomatic intracranial hemorrhage) were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). For the identification of outcome predictors, mixed models with center as random effect were fitted using the Akaike and Bayesian information criterion. 12 Comparisons between outcomes were further adjusted for prespecified confounding factors (age, admission ASPECTS, NIHSS, IV thrombolysis and time from symptom onset to reperfusion). Statistical testing was done at the two-tailed α level of 0.05. Data were analyzed using STATA software v17.
Results
A total of 2366 patients met our inclusion criteria and were enrolled in the final analysis (Figure 1). The baseline characteristics of the study groups are reported in Table 1. Compared to patients without ASPECTS evolution, patients with ASPECTS evolution were more likely to have diabetes (21.2% vs. 14.7%, p < 0.001), higher admission NIHSS stroke (17 8 vs. 16 10, p < 0.001) and lower admission ASPECTS score (8 3 vs. 7 2, p < 0.001). In addition, patients with ASPECTS evolution were less likely to have good collaterals (grades 3–4) (45.4% vs. 54.9%; p < 0.001), required more thrombectomy attempts, and were less likely to have complete reperfusion at the end of procedure. Procedure time was longer in patients with ASPECTS evolution compared to those without. In a fully adjusted model, ASPECTS evolution was a strong predictor of favorable outcome (aOR = 0.46; 95%CI = 0.37–0.57) (Table 2, Figure 2). There was no interaction between time from onset to puncture and the effect of ASPECTS on favorable outcome (Pinteraction = 0.52; Figure 3).
Figure 1.
Study flow chart.
Table 1.
Baseline characteristics, time metrics, and procedural metrics of the study cohort.
| Variable | Total | ASPECTS evolution | p-Value | Missing N (%) |
|
|---|---|---|---|---|---|
| No | Yes | ||||
| N (%) | 2366 (100.0) | 1499 (63.4) | 867 (36.6) | 0 / 2366 (0.00) | |
| Age, mean (SD) | 70 (15) | 70 (15) | 70 (14) | 0.735 | 1 / 2366 (0.04) |
| Female | 1168 (49.5) | 773 (51.7) | 395 (45.7) | 0.005 | 5 / 2366 (0.21) |
| Medical history | |||||
| Hypertension | 1436 (61.4) | 895 (60.5) | 541 (63.0) | 0.230 | 27 / 2366 (1.14) |
| Hyperlipidemia | 706 (30.4) | 443 (30.2) | 263 (30.9) | 0.706 | 46 / 2366 (1.94) |
| Smoking | 485 (21.6) | 318 (22.4) | 167 (20.2) | 0.236 | 120 / 2366 (5.07) |
| Diabetes mellitus | 397 (17.0) | 217 (14.7) | 180 (21.1) | 0.000 | 36 / 2366 (1.52) |
| Stroke | 380 (16.4) | 244 (16.6) | 136 (15.9) | 0.676 | 44 / 2366 (1.86) |
| Coronary artery disease | 403 (17.4) | 249 (17.0) | 154 (18.2) | 0.460 | 52 / 2366 (2.20) |
| Pre stroke mRS ≤ 2 | 2121 (92.4) | 1352 (92.9) | 769 (91.5) | 0.255 | 70 / 2366 (2.96) |
| Right side | 1126 (48.3) | 716 (48.4) | 410 (48.0) | 0.790 | 33 / 2366 (1.39) |
| Antithrombotic therapy | 1018 (43.9) | 622 (42.4) | 396 (46.6) | 0.046 | 49 / 2366 (2.07) |
| Current stroke event | |||||
| Admission SBP, mean (SD) | 147 (26) | 147 (27) | 148 (26) | 0.467 | 326 / 2366 (13.78) |
| Admission DBP (SD) | 82 (17) | 82 (17) | 82 (17) | 0.423 | 330 / 2366 (13.95) |
| Admission blood glucose, mean (SD) | 7 (3) | 7 (3) | 7 (3) | 0.006 | 451 / 2366 (19.06) |
| Admission NIHSS, median (IQR) | 16 (9) | 16 (10) | 17 (8) | 0.000 | 65 / 2366 (2.75) |
| Admission ASPECTS, median (IQR) | 7 (3) | 7 (2) | 8 (3) | 0.000 | 0 / 2366 (0.00) |
| Intravenous thrombolysis | 1235 (52.3) | 769 (51.4) | 466 (53.8) | 0.259 | 4 / 2366 (0.17) |
| Cardioembolic etiology | 1103 (51.3) | 685 (50.5) | 418 (52.8) | 0.304 | 217 / 2366 (9.17) |
| General anesthesia | 332 (14.1) | 168 (11.3) | 164 (19.0) | 0.000 | 14 / 2366 (0.59) |
| Imaging | |||||
| M1 occlusion | 1305 (55.2) | 828 (55.2) | 477 (55.0) | ||
| M2 occlusion | 402 (17.0) | 276 (18.4) | 126 (14.5) | ||
| ICA occlusion | 392 (16.6) | 236 (15.7) | 156 (18.0) | ||
| Tandem occlusion | 267 (11.3) | 159 (10.6) | 108 (12.5) | 0.042 | 0 / 2366 (0.00) |
| Good collateral grade | 739 (51.4) | 496 (54.9) | 243 (45.4) | 0.000 | 928 / 2366 (39.22) |
| Procedural characteristics | |||||
| First line thrombectomy strategy | |||||
| Stentriever | 221 (9.8) | 149 (10.4) | 72 (8.7) | ||
| Aspiration | 1074 (47.5) | 635 (44.4) | 439 (52.8) | ||
| Stentriever and aspiration | 956 (42.3) | 640 (44.8) | 316 (38.0) | ||
| Other | 10 (0.4) | 5 (0.3) | 5 (0.6) | 0.001 | 105 / 2366 (4.44) |
| Use of balloon catheter, N (%) | 522 (22.3) | 337 (22.7) | 185 (21.7) | 0.547 | 30 / 2366 (1.27) |
| Adjacent treatment with heparin | 233 (13.9) | 170 (16.4) | 63 (9.8) | 0.000 | 687 / 2366 (29.04) |
| Angioplasty | 197 (9.0) | 121 (8.7) | 76 (9.5) | 0.537 | 186 / 2366 (7.86) |
| Number of thrombectomy passes, median (IQR) | 2 (2) | 2 (2) | 2 (3) | 0.000 | 887 / 2366 (37.49) |
| First-pass mTICI 3 reperfusion (yes), N (%) | 427 (21.0) | 309 (24.0) | 118 (15.8) | 0.000 | 331 / 2366 (13.99) |
| Final mTICI, N (%) | |||||
| mTICI 2b | 690 (29.2) | 388 (25.9) | 302 (34.8) | ||
| mTICI 2c | 534 (22.6) | 341 (22.7) | 193 (22.3) | ||
| mTICI 3 | 1142 (48.3) | 770 (51.4) | 372 (42.9) | 0.000 | 0 / 2366 (0.00) |
| Complication, N (%) | 323 (13.7) | 177 (11.9) | 146 (16.9) | 0.001 | 9 / 2366 (0.38) |
| Emboli, N (%) | 99 (4.2) | 46 (3.1) | 53 (6.1) | 0.000 | 0 / 2366 (0.00) |
| Perforation, N (%) | 24 (1.0) | 13 (0.9) | 11 (1.3) | 0.348 | 0 / 2366 (0.00) |
| Dissection, N (%) | 22 (0.9) | 13 (0.9) | 9 (1.0) | 0.677 | 0 / 2366 (0.00) |
| Vasospasm, N (%) | 50 (2.1) | 26 (1.7) | 24 (2.8) | 0.092 | 0 / 2366 (0.00) |
| Workflow, median (IQR) | |||||
| Onset to puncture | 244 (135) | 240 (135) | 250 (137) | 0.008 | 103 / 2366 (4.35) |
| Puncture to reperfusion | 38 (33) | 37 (30) | 40 (39) | 0.002 | 82 / 2366 (3.47) |
| Onset to reperfusion | 287 (145) | 282 (138) | 300 (153) | 0.000 | 135 / 2366 (5.71) |
Values are expressed as number (%), mean (SD), or median (IQR)
ASPECTS: Alberta Stroke Program Early CT Scan; DBP, diastolic blood pressure; ICA: internal carotid artery; IQR: interquartile range; mRS: modified Rankin scale; mTICI: modified treatment in cerebral ischemia; NIHSS: National Institute of Health Stroke Scale; SBP, systolic blood pressure; SD: standard deviation.
Table 2.
Effect of ASPECTS evolution on primary and secondary outcomes.
| Outcome | Total | ASPECTS Evolution | p-Value | Missing N (%) | Unadjusted | Adjusted* | |||
|---|---|---|---|---|---|---|---|---|---|
| No | Yes | OR 95% CI | p | aOR 95% CI | p | ||||
| Favorable outcome, N (%) | 994 (46.7) | 710 (52.7) | 284 (36.5) | 0.000 | 239 / 2366 (10.10) | 0.51 (0.43–0.61) | <0.001 | 0.46 (0.37–0.57) | <0.001 |
| Excellent outcome, N (%) | 651 (30.6) | 477 (35.4) | 174 (22.3) | 0.000 | 239 / 2366 (10.10) | 0.52 (0.42–0.64) | <0.001 | 0.52 (0.49–0.57) | <0.001 |
| Early neurological improvement, N (%) | 1139 (48.1) | 791 (52.8) | 348 (40.1) | 0.000 | 0 / 2366 (0.00) | 0.60 (0.50–0.71) | <0.001 | 0.42 (0.35–0.51) | <0.001 |
| Parenchymal hemorrhage (yes), N (%) | 310 (13.7) | 138 (9.8) | 172 (20.3) | 0.000 | 106 / 2366 (4.48) | 2.35 (1.85–3.00) | <0.001 | 2.64 (2.03–3.44) | <0.001 |
| Symptomatic intracerebral hemorrhage, N (%) | 160 (7.0) | 77 (5.4) | 83 (9.8) | 0.000 | 87 / 2366 (3.68) | 1.90 (1.37–2.62) | <0.001 | 2.28 (1.61–3.21) | <0.001 |
| Death, N (%) | 403 (18.9) | 214 (15.9) | 189 (24.3) | 0.000 | 239 / 2366 (10.10) | 1.69 (1.36–2.11) | <0.001 | 1.90 (1.48–2.44) | <0.001 |
*Adjusted for age, initial ASPECTS, initial NIHSS, IV thrombolysis, time from onset to reperfusion with a mixed model with center as random effect after multiple imputation (m = 10).
aOR: adjusted odds ratio; ASPECTS: Alberta Stroke Program Early CT Scan; CI: confidence interval; IV: intravenous; NIHSS: National Institute of Health Stroke Scale.
Figure 2.
Modified Rankin scale score at 90 days distribution according to ASPECTS evolution.
Figure 3.
Predicted probabilities with 95% confidence interval for favorable outcome shown for patients with and without ASPECTS evolution at different times from symptoms onset.
In addition, ASPECTS evolution was a predictor of excellent outcome (adjusted OR (aOR) = 0.52; 95% CI = 0.49–0.57) and early neurological improvement (aOR = 0.42; 95% CI = 0.35–0.51). With respect to safety outcomes, ASPECTS evolution was associated with higher risk of parenchymal hemorrhage (aOR = 2.64; 95% CI = 2.03–3.44) and symptomatic intracerebral hemorrhage (aOR = 2.28; 95% CI = 1.61–3.21) (Table 2). Sensitivity analysis limited to patients who had MRI on admission and at 24 hours revealed similar results (Table I in Supplemental materials).
Stroke severity (aOR = 1.06; 95% CI = 1.01–1.08), admission ASPECTS (aOR = 1.31; 95% CI = 1.19–1.44), total number of passes (aOR = 1.25; 95% CI = 1.13–1.38), complete reperfusion (aOR = 0.55; 95%CI = 0.40–0.78), and good collaterals (aOR = 0.63; 95% CI = 0.45–0.88) emerged as predictors of ASPECTS evolution (Table 3). In a sensitivity analysis limited to patients who had MRI on admission and at 24 hours, only admission ASPECTS, total number of passes and complete reperfusion emerged as predictors of ASPECTS evolution (Table II in Supplemental Material).
Table 3.
Predictors of ASPECTS evolution.
| Predictor | Odds ratio | p-Value | 95% CI | |
|---|---|---|---|---|
| Age | .999254 | 0.898 | .9879682 | 1.010669 |
| Admission NIHSS | 1.06003 | 0.000 | 1.031048 | 1.089827 |
| Admission ASPECTS | 1.316525 | 0.000 | 1.19979 | 1.444619 |
| IV Thrombolysis | 1.243219 | 0.192 | .8965736 | 1.72389 |
| Time from onset to reperfusion | 1.000652 | 0.281 | .9994669 | 1.001838 |
| Total number of passes | 1.254826 | 0.000 | 1.135632 | 1.386529 |
| mTICI 3 (vs. mTICI 2b-c) | .5597842 | 0.001 | .4006428 | .7821389 |
| Collateral grades 3–4 | .6317227 | 0.008 | .4502261 | .8863848 |
ASPECTS: Alberta Stroke Program Early CT Scan; CI: confidence interval; IV: intravenous; mTICI: modified treatment in cerebral ischemia; NIHSS: National Institute of Health Stroke Scale.
Discussion
We demonstrated a strong association between ASPECTS evolution and poor functional outcome after successful reperfusion in the early and extended time window. Moreover, ASPECTS evolution was a strong predictor of hemorrhagic complications and mortality after successful reperfusion. Total number of attempts and admission ASPECTS were consistent predictors of ASPECTS evolution after successful reperfusion.
There is accumulating evidence suggesting the importance of 24-hour ASPECTS and ASPECTS evolution in patients with large vessel occlusion. A post hoc analysis of the SWIFT demonstrated a link between 24-hour ASPECTS and poor outcome. Moreover, dramatic infarct expansion (defined as ≥6 points decrease in ASPECTS at 24 hours) was predicted by blood glucose and failure to achieve reperfusion. 5 Similarly, a post hoc analysis of the DAWN trial also demonstrated an association between 24-hour ASPECTS and poor functional outcome. 6 Both previous studies highlighted the importance of 24-hour ASPECTS. However, both studies were limited by small sample size. Our study enrolled a significantly larger sample size and represents a real-world experience. There are additional key differences in the inclusion criteria between our study and the previous studies: (1) we included only patients with successful reperfusion at the end of EVT and (2) we included patients regardless of time from onset to puncture and stroke severity. Similar to previous studies, ASPECTS evolution was a strong predictor of poor outcome after successful reperfusion and patients with one or more point decrease in ASPECTS had almost 50% less chance of achieving functional independence at 90 days. Interestingly, 63% of our patients did not have worsening in their ASPECTS after successful reperfusion compared to 40% in the DAWN endovascular arm which is likely due to the fact that we only included patients with successful reperfusion. In addition, patients with ASPECTS evolution had almost double the risk of hemorrhagic complications compared to those without.
Complete reperfusion (mTICI 3) compared to successful but incomplete reperfusion (mTICI 2b) was a strong predictor of ASPECTS evolution (negative association) in our cohort, as previously reported. 13 Moreover, number of attempts was a consistent predictor of ASPECTS evolution after successful reperfusion. These findings highlight the importance of complete and fast reperfusion to prevent infarct expansion in patients presenting with acute stroke due to large vessel occlusion.14,15 Interestingly, time from onset to puncture and intravenous thrombolysis did not emerge as predictors of ASPECTS evolution after successful reperfusion.
One of the main challenges of assessing ASPECTS evolution is the inconsistent imaging protocols on admission and at 24 hours. The above mentioned DWAN post hoc analysis noted that ASPECTS change was sensitive to the imaging modality. 6 To address this concern, we performed a sensitivity analysis limited to patients who underwent MRI on admission and at 24 hours. The results of the sensitivity analysis were similar to the primary analysis and showed a strong association between ASPECTS evolution and poor functional outcome and higher risk of hemorrhagic complications. Our results, along with the previous studies’ results,5,6 suggest that ASPECTS evolution is a strong predictor of outcome after EVT in day-to-day practice and can be used as a marker for early assessment of treatment efficacy even when assessed on two different modalities.
This study has multiple limitations that should be considered while interpreting our results. There was no central adjudication of any of the clinical or imaging outcomes. However, it should be noted that procedural and preprocedural and postprocedural imaging were reviewed and assessed by local experienced neuroradiologists (>10 years of experience) blinded to clinical outcomes at each center. Moreover, both MRI and CT modalities were used to score ASPECTS which could have altered our results. However, as mentioned above, sensitivity analysis limited to patients with MRI on admission and at 24 hours revealed similar results.
Conclusion
In current practice, ASPECTS evolution is a strong predictor of functional and safety outcomes after successful endovascular therapy and could be used as a marker for early assessment of treatment efficacy. Higher number of attempts and incomplete reperfusion are associated with ASPECTS evolution.
Supplemental Material
Supplemental material, sj-docx-1-ine-10.1177_15910199231196953 for ASPECTS evolution after endovascular successful reperfusion in the early and extended time window by Mohammad Anadani, Stephanos Finitsis, Raoul Pop, Jean Darcourt, Frédéric Clarençon, Sébastien Richard, Adam de Havenon, David Liebeskind, Gaultier Marnat, Romain Bourcier, Igor Sibon, Cyril Dargazanli, Caroline Arquizan, Raphaël Blanc, Bertrand Lapergue, Arturo Consoli, François Eugène, Stéphane Vannier, Jildaz Caroff, Christian Denier, Marion Boulanger, Maxime Gauberti, Suzana Saleme, Francisco Macian, Charlotte Rosso, Guillaume Turc, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Jean-Marc Olivot, Anthony Le Bras, Sarah Evain, Valérie Wolff, Serge Timsit, Jean-Christophe Gentric, Frédéric Bourdain, Louis Veunac, Benjamin Maïer, Wagih Ben Hassen, Benjamin Gory, and On behalf of the ETIS Registry Investigators in Interventional Neuroradiology
List of Endovascular Treatment in Ischemic Stroke (ETIS) Investigators:
Rothschild Foundation: Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, François Delvoye, Stanislas Smajda, Benjamin Maïer, Solène Hebert, Mikael Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy.
Foch Hospital: Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, Bertrand Lapergue, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier.
CHU Bordeaux: Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon.
CHU Nantes: Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre.
CHRU-Nancy: Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Gérard Audibert, Marcela Voicu, Ionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar, Sarah Guy, Valérie Geirges, Fatiha Bechiri.
CHU Limoges: Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard.
CHRU Gui de Chauliac: Vincent Costalat, Caroline Arquizan, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst.
CHU Rennes: Francois Eugene, Stéphane Vannier, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault.
CHU Pitié-Salpêtrière: Frédéric Clarençon, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson, Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos.
CHU Kremlin-Bicêtre: Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti, Mariana Sarov, Nicolas Legris.
Hôpital Saint-Anne: Olivier Naggara, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Guillaume Turc, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun.
CHU Toulouse: Alain Viguier, Christophe Cognard, Anne-Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean-François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall.
CHU Caen: Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti.
CHU Brest: Serge Timsit, Jean-Christophe Gentric, Julien Ognard, Francois Mathias Merrien.
CHU Rouen: Ozlem Ozku Wermester, Evelyne Massardier, Chrysanthi Papagiannaki, Aude Triquenot, Margeaux Lefebvre.
CH Bayonne: Frédéric Bourdain, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue.
CHU Strasbourg: Valérie Wolff, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Raoul Pop, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran.
CH Vannes: Anthony Le Bras, Sarah Evain, Arnaud Le Guen.
Footnotes
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs: Mohammad Anadani https://orcid.org/0000-0002-7813-2949
Raoul Pop https://orcid.org/0000-0003-4417-1496
David Liebeskind https://orcid.org/0000-0002-5109-8736
Gaultier Marnat https://orcid.org/0000-0002-7611-7753
Jildaz Caroff https://orcid.org/0000-0002-0029-1835
Supplemental Material: Supplemental material for this article is available online.
References
- 1.Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731. [DOI] [PubMed] [Google Scholar]
- 2.Demeestere J, Garcia-Esperon C, Garcia-Bermejo P, et al. Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume. Neurology 2017; 88: 2248–2253. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hungerford JP, Hyer M, Turk AS, et al. Impact of ASPECT scores and infarct distribution on outcomes among patients undergoing thrombectomy for acute ischemic stroke with the ADAPT technique. Journal of NeuroInterventional Surgery 2017; 9: 823–829. [DOI] [PubMed] [Google Scholar]
- 4.Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50: e344–e418. [DOI] [PubMed] [Google Scholar]
- 5.Liebeskind DS, Jahan R, Nogueira RG, et al. Serial Alberta stroke program early CT score from baseline to 24 hours in solitaire flow restoration with the intention for thrombectomy study: a novel surrogate end point for revascularization in acute stroke. Stroke 2014; 45: 723–727. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Liebeskind DS, Saber H, Bhuva P, et al. Serial ASPECTS in the DAWN trial: infarct evolution and clinical impact. Stroke 2021; 52: 3318–3324. [DOI] [PubMed] [Google Scholar]
- 7.Zhu F, Lapergue B, Kyheng M, et al. Similar outcomes for contact aspiration and stent retriever use according to the admission clot burden score in ASTER. Stroke 2018; 49: 1669–1677. [DOI] [PubMed] [Google Scholar]
- 8.Higashida RT, Furlan AJ, Roberts H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003; 34: e109–e137. [DOI] [PubMed] [Google Scholar]
- 9.Anadani M, Finitsis S, Clarencon F, et al. Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry. Journal of Neuorinterventional Surgery 2022; 14: 551–557. [DOI] [PubMed] [Google Scholar]
- 10.Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317–1329. [DOI] [PubMed] [Google Scholar]
- 11.Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017–1025. [PubMed] [Google Scholar]
- 12.Burnham KP, Anderson DR. Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res 2004; 33: 261–304. [Google Scholar]
- 13.Kaesmacher J, Dobrocky T, Heldner MR, et al. Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. J Neurol Neurosurg Psychiatry 2018 Sep; 89: 910–917. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.McTaggart RA, Ospel JM, Psychogios M-N, et al. Optimization of endovascular therapy in the neuroangiography suite to achieve fast and complete (expanded treatment in cerebral ischemia 2c-3) reperfusion. Stroke 2020; 51: 1961–1968. [DOI] [PubMed] [Google Scholar]
- 15.Anadani M, Alawieh A, Vargas J, et al. First attempt recanalization with ADAPT: rate, predictors, and outcome. J Neurointerv Surg 2019; 11: 641–645. [DOI] [PubMed] [Google Scholar]
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Supplementary Materials
Supplemental material, sj-docx-1-ine-10.1177_15910199231196953 for ASPECTS evolution after endovascular successful reperfusion in the early and extended time window by Mohammad Anadani, Stephanos Finitsis, Raoul Pop, Jean Darcourt, Frédéric Clarençon, Sébastien Richard, Adam de Havenon, David Liebeskind, Gaultier Marnat, Romain Bourcier, Igor Sibon, Cyril Dargazanli, Caroline Arquizan, Raphaël Blanc, Bertrand Lapergue, Arturo Consoli, François Eugène, Stéphane Vannier, Jildaz Caroff, Christian Denier, Marion Boulanger, Maxime Gauberti, Suzana Saleme, Francisco Macian, Charlotte Rosso, Guillaume Turc, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Jean-Marc Olivot, Anthony Le Bras, Sarah Evain, Valérie Wolff, Serge Timsit, Jean-Christophe Gentric, Frédéric Bourdain, Louis Veunac, Benjamin Maïer, Wagih Ben Hassen, Benjamin Gory, and On behalf of the ETIS Registry Investigators in Interventional Neuroradiology