• Albert J Yoo, Osama O Zaidat, Zeshan A Chaudhry, Olvert A Berkhemer, R Gilberto González, Mayank Goyal, Andrew M Demchuk, Bijoy K Menon, Elan Mualem, Dawn Ueda, Hope Buell, Siu Po Sit, Arani Bose, and Penumbra Pivotal and Penumbra Imaging Collaborative Study (PICS) Investigators.
• From Massachusetts General Hospital, Boston, MA (A.J.Y., Z.A.C., O.A.B., R.G.G.); Medical College of Wisconsin, Milwaukee, WI (O.O.Z.); University of Calgary, Calgary, AB, Canada (M.G., A.M.D., B.K.M.); Penumbra Inc, Alameda, CA (E.M., D.U., H.B., S.P.S., A.B.).
• Stroke. 2014 Mar 1; 45 (3): 746-51.

Background And PurposeThe efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT.MethodsThe study cohort was derived from multicenter trials of the Penumbra System. Inclusion criteria were anterior circulation proximal occlusion, evaluable pretreatment NCCT, and known time to reperfusion. Ischemic change was quantified using the Alberta Stroke Program Early CT Score (ASPECTS) and stratified into 3 prespecified groups for comparison: 0 to 4 (most ischemic change) versus 5 to 7 versus 8 to 10 (least ischemic change).ResultsA total of 249 patients were analyzed: 40 with ASPECTS 0 to 4, 83 with ASPECTS 5 to 7, and 126 with ASPECTS 8 to 10. For ASPECTS 0 to 4, 5 to 7, and 8 to 10, respectively, good outcome (modified Rankin Scale score, 0-2) rates were 5%, 38.6%, and 46% (P<0.0001), and mortality rates were 55%, 28.9%, and 19% (P=0.0001). The only significant pairwise differences were between ASPECTS 0 to 4 and other groups. Symptomatic hemorrhage was more common with lower ASPECTS (P=0.02). Shorter time to reperfusion was significantly associated with better outcomes among patients with ASPECTS 8 to 10 (P=0.01). A similar relationship was seen for ASPECTS 5 to 7 but was not statistically significant. No such relationship was seen for ASPECTS 0 to 4.ConclusionsNCCT seems useful for excluding patients with the greatest burden of ischemic damage from futile intra-arterial treatment, which is unlikely to result in patient functional independence and increases the risk of hemorrhage.

34 keywords...

hide…