1. Endovascular therapy in acute ischaemic stroke with large infarction with matched or mismatched clinical-radiological severities: a post-hoc analysis of the ANGEL-ASPECT trialResearch in context
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Lina Zheng, Ximing Nie, Mengxing Wang, Xin Liu, Wanying Duan, Zhe Zhang, Jingyi Liu, Yufei Wei, Miao Wen, Zhonghua Yang, Thomas W. Leung, Gaoting Ma, Xiaochuan Huo, Yuesong Pan, Thanh N. Nguyen, Xinyi Leng, Zhongrong Miao, Liping Liu, Yongjun Wang, Yilong Wang, David S. Liebeskind, Zeguang Ren, Vitor Mendes Pereira, Xunming Ji, Qiang Dong, Anding Xu, Xinfeng Liu, Qingwu Yang, Jing Jing (Chair), Yingkui Zhang, Wei Wu, Dapeng Sun, Zhongqi Qi, Shuo Li, Zhenqiang Liu, Zequan Yu, Jingyu Zhang, Fangguang Chen, Kangyue Li, Kai Zhang, Mingkai Hu, Jianmin Liu (Chair), Chen Yao, Kangning Chen, Kun Fang (Chair), Bo Song, Yi Dong, Guangxiong Yuan, Hongxing Han, Wenhuo Chen, Ming Wei, Jiangang Zhang, Zhiming Zhou, Xiaoxi Yao, Guoqing Wang, Weigen Song, Xueli Cai, Guangxian Nan, Di Li, Yizhou Wang, Wentong Ling, Chuwei Cai, Changming Wen, En Wang, Liyong Zhang, Changchun Jiang, Yajie Liu, Geng Liao, Xiaohui Chen, Tianxiao Li, Shudong Liu, Jinglun Li, Yaxuan Sun, Na Xu, Zong’en Gao, Dongsheng Ju, Cunfeng Song, Jinggang Xuan, Feng Zhou, Qing Shi, Jun Luo, Yan Liu, Zaiyu Guo, Tong Li, Hongbo Zheng, Linzhi Dai, Junfeng Zhao, Liqiang Gui, Xiaokun Geng, Yufeng Tang, Congguo Yin, Hua Yang, Ruiyang An, Yuying Sun, Yanan Wu, Chunlai Yu, Shuangcheng Zheng, Aoming Jin, Xianglong Xiang, Hongyi Yan, Yuanling He, Chunyang Li, Weixia Kong, Yuhuan Chen, Chenhao Guo, Fengjie Ji, Pengshan Ji, Lei Liu, Xinghua Lu, Guangkuo Luo, Nanjing Wang, Yu Zhang, Bo Liu, Jian Yang, Jingjing Deng, Juan Wang, Wanru Wang, Hang Yu, Le Cui, Wenwen Liu, Ziyong Wang, Xia Zhao, Zhou Zhou, and Alvin Yi-Chou Wang
- Subjects
Endovascular therapy ,Acute ischaemic stroke ,Large vessel occlusion ,Large infarct core ,Post hoc analysis ,Medicine (General) ,R5-920 - Abstract
Summary: Background: Endovascular therapy (EVT) was demonstrated effective in acute large vessel occlusion (LVO) with large infarction. Revealing subgroups of patients who would or would not benefit from EVT will further inform patient selection for EVT. Methods: This post-hoc analysis of the ANGEL-ASPECT trial, a randomised controlled trial of 456 adult patients with acute anterior-circulation LVO and large infarction, defined by ASPECTS 3–5 or infarct core volume 70–100 mL, enrolled from 46 centres across China, between October 2, 2020 and May 18, 2022. Patients were randomly assigned (1:1) to receiving EVT and medical management or medical management alone. One patient withdrew consent, 455 patients were included in this post-hoc analysis and categorised into 4 subgroups by lower or higher NIHSS (< or ≥16) and smaller or larger infarct core (< or ≥70 mL). Those with lower NIHSS & smaller core, and higher NIHSS & larger core were considered clinical-radiological matched subgroups; otherwise clinical-radiological mismatched subgroups. Primary outcome was 90-day modified Rankin Scale (mRS). ANGEL-ASPECT is registered with ClinicalTrials.gov, NCT04551664. Findings: Overall, 139 (30.5%) patients had lower NIHSS & smaller core, 106 (23.3%) higher NIHSS & larger core, 130 (28.6%) higher NIHSS & smaller core, and 80 (17.6%) lower NIHSS & larger core. There was significant ordinal shift in the 90-day mRS toward a better outcome with EVT in clinical-radiological matched subgroups: lower NIHSS & smaller core (generalised OR, 1.76; 95% CI, 1.18–2.62; p = 0.01) and higher NIHSS & larger core (1.64; 1.06–2.54; 0.01); but not in the two clinical-radiological mismatched subgroups. Interpretation: Our findings suggested that in patients with anterior-circulation LVO and large infarction, EVT was associated with improved 90-day functional outcomes in those with matched clinical and radiological severities, but not in those with mismatched clinical and radiological severities. Simultaneous consideration of stroke severity and infarct core volume may inform patient selection for EVT. Funding: Unrestricted grants from industry [Covidien Healthcare International Trading (Shanghai), Johnson & Johnson MedTech, Genesis MedTech (Shanghai), and Shanghai HeartCare Medical Technology].
- Published
- 2024
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