Association of Mismatch Profiles and Clinical Outcome from Endovascular Therapy in Large Infarct: A Post-Hoc Analysis of the ANGEL-ASPECT Trial

被引：7

作者：

Huo, Xiaochuan ^{[1
]}

Nguyen, Thanh N. ^{[3
]}

Sun, Dapeng ^{[2
,4
]}

Pan, Yuesong ^{[2
,4
]}

Ma, Gaoting ^{[5
]}

Tong, Xu ^{[2
]}

Wang, Mengxing ^{[4
]}

Ma, Ning ^{[2
,4
]}

Gao, Feng ^{[2
,4
]}

Mo, Dapeng ^{[2
,4
]}

Abdalkader, Mohamad ^{[3
]}

Masoud, Hesham E. ^{[6
]}

Nogueira, Raul G. ^{[7
]}

Miao, Zhongrong ^{[2
,4
]}

ANGEL ASPECT Study Grp

机构：

[1] Capital Med Univ, Beijing Anzhen Hosp, Neurol Dis Ctr, Cerebrovasc Dis Dept, 2 Anzhen Rd, Beijing 100029, Peoples R China

[2] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Intervent Neuroradiol, 119 South 4th Ring West Rd, Beijing 100070, Peoples R China

[3] Boston Med Ctr, Dept Neurol, Radiol, Boston, MA USA

[4] Capital Med Univ, Beijing Tiantan Hosp, China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China

[5] Capital Med Univ, Xuanwu Hosp, Dept Neurol, Beijing, Peoples R China

[6] Upstate Univ Hosp, Dept Neurol, Syracuse, NY USA

[7] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA USA

来源：

ANNALS OF NEUROLOGY | 2024年 / 96卷 / 04期

关键词：

ISCHEMIC-STROKE; VOLUME; THROMBECTOMY; ACCURACY; SOFTWARE; CT;

D O I：

10.1002/ana.27017

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 (T-max) >6 s cerebral volume/ischemic core volume, and mismatch volume was defined as T-max >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.

引用

页码：729 / 738

页数：10

共 27 条

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Dowling, R. J. ;

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Davis, Stephen M. ;

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Bracard, Serge ;

Muir, Keith W. ;

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Jovin, Tudor G. ;

Albucher, J. F. ;

Cognard, Christophe ;

Henon, Hilde ;

Nouri, Nasreddine ;

Gory, Benjamin ;

Richard, Sebastien ;

Marnat, Gaultier ;

Sibon, Igor ;

Di Maria, Federico ;

Annan, Mariam ;

Boulouis, Gregoire ;

Cardona, Pere ;

Obadia, Michael ;

Piotin, Michel ;

Bourcier, Romain ;

Guillon, Benoit ;

Godard, Sophie ;

Pasco-Papon, Anne ;

Eker, Omer F. ;

Cho, Tae-Hee ;

Turc, Guillaume ;

Naggara, Olivier ;

Velasco, Stephane ;

Lamy, Matthias ;

Clarencon, Frederic ;

Alamowitch, Sonia ;

Renu, Arturo ;

Suissa, Laurent ;

Brunel, Herve ;

Gentric, Jean-Christophe ;

Timsit, Serge ;

Lamy, Chantal ;

Chivot, Cyril ;

Macian-Montoro, Francisco ;

Mounayer, Charbel ;

Ozkul-Wermester, Ozlem ;

Papagiannaki, Chrysanthi ;

Wolff, Valerie ;

Pop, Raoul ;

Ferrier, Anna ;

Chabert, Emmanuel ;

Ricolfi, Frederic ;

Bejot, Yannick ;

Lopez-Cancio, Elena ;

Vega, Pedro ;

Spelle, Laurent ;

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Millan, Monica .

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Roos, Yvo B. ;

van Zwam, Wim ;

van Oostenbrugge, Robert J. ;

Goyal, Mayank ;

Saver, Jeffrey L. ;

Jovin, Tudor G. ;

Albers, Gregory W. ;

Davalos, Antoni ;

Hill, Michael D. ;

Demchuk, Andrew M. ;

Bracard, Serge ;

Guillemin, Francis ;

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← 1 2 3 →

共 27 条

[1] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[2] Assessment of Optimal Patient Selection for Endovascular Thrombectomy Beyond 6 Hours After Symptom Onset A Pooled Analysis of the AURORA Database [J].

Albers, Gregory W. ;

Lansberg, Maarten G. ;

Brown, Scott ;

Jadhav, Ashutosh P. ;

Haussen, Diogo C. ;

Martins, Sheila O. ;

Rebello, Leticia C. ;

Demchuk, Andrew M. ;

Goyal, Mayank ;

Ribo, Marc ;

Turk, Aquilla S. ;

Liebeskind, David S. ;

Heit, Jeremy J. ;

Marks, Michael P. ;

Jovin, Tudor G. ;

Nogueira, Raul G. .

JAMA NEUROLOGY, 2021, 78 (09) :1064-1071

[3] Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy [J].

Austein, Friederike ;

Riedel, Christian ;

Kerby, Tina ;

Meyne, Johannes ;

Binder, Andreas ;

Lindner, Thomas ;

Huhndorf, Monika ;

Wodarg, Fritz ;

Jansen, Olav .

STROKE, 2016, 47 (09) :2311-2317

[4] Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial [J].

Bendszus, Martin ;

Fiehler, Jens ;

Subtil, Fabien ;

Bonekamp, Susanne ;

Aamodt, Anne Hege ;

Fuentes, Blanca ;

Gizewski, Elke R. ;

Hill, Michael D. ;

Krajina, Antonin ;

Pierot, Laurent ;

Simonsen, Claus Z. ;

Zelenak, Kamil ;

Blauenfeldt, Rolf A. ;

Cheng, Bastian ;

Denis, Angelique ;

Deutschmann, Hannes ;

Dorn, Franziska ;

Flottmann, Fabian ;

Gellissen, Susanne ;

Gerber, Johannes C. ;

Goyal, Mayank ;

Haring, Jozef ;

Herweh, Christian ;

Hopf-Jensen, Silke ;

Hua, Vi Tuan ;

Jensen, Maerit ;

Kastrup, Andreas ;

Keil, Christiane Fee ;

Klepanec, Andrej ;

Kurca, Egon ;

Mikkelsen, Ronni ;

Moehlenbruch, Markus ;

Mueller-Huelsbeck, Stefan ;

Muennich, Nico ;

Pagano, Paolo ;

Papanagiotou, Panagiotis ;

Petzold, Gabor C. ;

Pham, Mirko ;

Puetz, Volker ;

Raupach, Jan ;

Reimann, Gernot ;

Ringleb, Peter Arthur ;

Schell, Maximilian ;

Schlemm, Eckhard ;

Schoenenberger, Silvia ;

Tennoe, Bjorn ;

Ulfert, Christian ;

Valis, Katerina ;

Vitkova, Eva ;

Vollherbst, Dominik F. .

LANCET, 2023, 402 (10414) :1753-1763

[5] Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke [J].

Boers, Anna M. M. ;

Jansen, Ivo G. H. ;

Brown, Scott ;

Lingsma, Hester F. ;

Beenen, Ludo F. M. ;

Devlin, Thomas G. ;

San Roman, Luis ;

Heo, Ji-Hoe ;

Ribo, Marc ;

Almekhlafi, Mohammed A. ;

Liebeskind, David S. ;

Teitelbaum, Jeanne ;

Cuadras, Patricia ;

de Rochemont, Richard du Mesnil ;

Beaumont, Marine ;

Brown, Martin M. ;

Yoo, Albert J. ;

Donnan, Geoffrey A. ;

Mas, Jean Louis ;

Oppenheim, Catherine ;

Dowling, Richard J. ;

Moulin, Thierry ;

Agrinier, Nelly ;

Lopes, Demetrius K. ;

Aja Rodriguez, Lucia ;

Compagne, Kars C. J. ;

Al-Ajlan, Fahad S. ;

Madigan, Jeremy ;

Albers, Gregory W. ;

Soize, Sebastien ;

Blasco, Jordi ;

Davis, Stephen M. ;

Nogueira, Raul G. ;

Davalos, Antoni ;

Menon, Bijoy K. ;

van der Lugt, Aad ;

Muir, Keith W. ;

Roos, Yvo B. W. E. M. ;

White, Phil ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

van Zwam, Wim H. ;

Jovin, Tudor G. ;

van Oostenbrugge, Robert J. ;

Dippel, Diederik W. J. ;

Campbell, Bruce C. V. ;

Guillemin, Francis ;

Bracard, Serge ;

Hill, Michael D. ;

Goyal, Mayank .

JAMA NEUROLOGY, 2019, 76 (02) :194-202

[6] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

Campbell, Bruce C. V. ;

Majoie, Charles B. L. M. ;

Albers, Gregory W. ;

Menon, Bijoy K. ;

Yassi, Nawaf ;

Sharma, Gagan ;

van Zwam, Wim H. ;

van Oostenbrugge, Robert J. ;

Demchuk, Andrew M. ;

Guillemin, Francis ;

White, Philip ;

Davalos, Antoni ;

van der Lugt, Aad ;

Butcher, Kenneth S. ;

Cherifi, Aboubaker ;

Marquering, Henk A. ;

Cloud, Geoffrey ;

Macho Fernandez, Juan M. ;

Madigan, Jeremy ;

Oppenheim, Catherine ;

Donnan, Geoffrey A. ;

Roos, Yvo B. W. E. M. ;

Shankar, Jai ;

Lingsma, Hester ;

Bonafe, Alain ;

Raoult, Helene ;

Hernandez-Perez, Maria ;

Bharatha, Aditya ;

Jahan, Reza ;

Jansen, Olav ;

Richard, Sebastien ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Soudant, Marc ;

Aja, Lucia ;

Davis, Stephen M. ;

Krings, Timo ;

Tisserand, Marie ;

San Roman, Luis ;

Tomasello, Alejandro ;

Beumer, Debbie ;

Brown, Scott ;

Liebeskind, David S. ;

Bracard, Serge ;

Muir, Keith W. ;

Dippel, Diederik W. J. ;

Goyal, Mayank ;

Saver, Jeffrey L. ;

Jovin, Tudor G. ;

Hill, Michael D. .

LANCET NEUROLOGY, 2019, 18 (01) :46-55

[8] Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size [J].

Costalat, Vincent ;

Jovin, Tudor G. ;

Albucher, J. F. ;

Cognard, Christophe ;

Henon, Hilde ;

Nouri, Nasreddine ;

Gory, Benjamin ;

Richard, Sebastien ;

Marnat, Gaultier ;

Sibon, Igor ;

Di Maria, Federico ;

Annan, Mariam ;

Boulouis, Gregoire ;

Cardona, Pere ;

Obadia, Michael ;

Piotin, Michel ;

Bourcier, Romain ;

Guillon, Benoit ;

Godard, Sophie ;

Pasco-Papon, Anne ;

Eker, Omer F. ;

Cho, Tae-Hee ;

Turc, Guillaume ;

Naggara, Olivier ;

Velasco, Stephane ;

Lamy, Matthias ;

Clarencon, Frederic ;

Alamowitch, Sonia ;

Renu, Arturo ;

Suissa, Laurent ;

Brunel, Herve ;

Gentric, Jean-Christophe ;

Timsit, Serge ;

Lamy, Chantal ;

Chivot, Cyril ;

Macian-Montoro, Francisco ;

Mounayer, Charbel ;

Ozkul-Wermester, Ozlem ;

Papagiannaki, Chrysanthi ;

Wolff, Valerie ;

Pop, Raoul ;

Ferrier, Anna ;

Chabert, Emmanuel ;

Ricolfi, Frederic ;

Bejot, Yannick ;

Lopez-Cancio, Elena ;

Vega, Pedro ;

Spelle, Laurent ;

Denier, Christian ;

Millan, Monica .

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