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Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis

journal contribution
posted on 2019-01-01, 00:00 authored by Kevin Phan, Serag Saleh, Adam A Dmytriw, Julian MaingardJulian Maingard, Christen Barras, Joshua A Hirsch, Terry Kok, Mark Brooks, Ronil V Chandra, Hamed AsadiHamed Asadi
BACKGROUND: Prompt revascularization of the ischemic penumbra following an acute ischemic event (AIS) has established benefit within the literature. However, use of the semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS) to evaluate patient suitability for revascularization has been inconsistent in patient risk stratification and selection. OBJECTIVE: To conduct a meta-analysis to evaluate the available evidence for a clinically valid ASPECTS threshold in assessment of suitability for revascularization following AIS. METHODS: Two independent reviewers searched Medline (Ovid) and Cochrane Central Register of Systematic Reviews databases for studies appraising outcomes of endovascular thrombectomy (EVT) in relation to a variably-defined preoperative ASPECTS. RESULTS: A total of 13 articles were included. The pooled good outcome proportion after EVT was 41.4% (95% CI 36.4% to 46.6%; p<0.001), with subjective study-specific definitions of favorable and unfavorable subgroup outcomes of 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) and 33.2% (95% CI 28.5% to 38.3%; I2=33.16%), respectively. Objective trichotomization into low (0-4), intermediate (5-7), and high (8-10) subgroups yielded pooled good outcome proportions of 17.1% (95% CI 6.8% to 36.8%; I2=64.24%; p=0.039), 35.7% (95% CI 30.5% to 41.3%; I2=23.11%; p=0.245), and 49.7% (95% CI 44.2% to 55.3%; I2=76.5%; p<0.001) for low, intermediate, and high ASPECTS, respectively. CONCLUSIONS: A subjectively favorable ASPECTS is associated with significantly better outcomes after EVT than an unfavorable ASPECTS, regardless of the cut-off used. EVT is unlikely to be useful in patients with an objectively low ASPECTS and is likely to be useful for those with high ASPECTS; findings in patients with intermediate ASPECTS were equivocal.

History

Journal

Journal of neuroInterventional surgery

Volume

11

Issue

7

Pagination

664 - 669

Publisher

BMJ Publishing Group

Location

London, Eng.

ISSN

1759-8478

eISSN

1759-8486

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2018, The Authors

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