Abstract TP31: Endovascular Thrombectomy for Patients With Acute Stroke With Low Aspect Score

• Published in: Stroke (1970) 2019-02, Vol.50 (Suppl_1)
• Main Authors: Tetsuya, Ioku, Keisuke, Imai, Masashi, Hamanaka, Masahiro, Itsukage, Kazuma, Tsuto, Atsushi, Yamamoto, toshi, Sai, Masanori, Cho, Kanako, Menjo, Hidekazu, Yamazaki
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.50.suppl_1.TP31

Abstract only Background: It is generally believed that patientswith acute stroke with ASPECT score (ASPECTS) ≥6 benefit from endovascular thrombectomy.OBJECTIVE:The purpose of the study was to examine the benefit of endovascular thrombectomy for stroke patients with low ASPECTS. Materials and Methods: Among 425 consecutive stroke patients treated with endovascular recanalization for occlusion of the anterior circulation at our hospital from March 2007 to June 2018, those with ASPECTS≤6 were included in the study. These patients were classified into three groups based on ASPECTS of 6 (APS6), 5 (APS5), and ≤4 (APS4). Preprocedural factors, procedures, and angiographic and clinical outcomes were compared among the three groups. Results: A total of 125 patients were included in the analysis, with 48, 39, and 38 in the APS6, APS5, and APS4 groups, respectively. Median age (75, 77, and 80 years), median DWI-ASPECTS (5, 3, and 3), sparing of pyramidal tract (33, 20, and 8), median baseline NIHSS (21, 23, and 23), occluded site (ICA-MCA: 16-32, 16-23, and 19-19), median onset to door time (128, 204, and 220 min), median door to puncture time (98, 74, and 74 min), intravenous rt-PA (8, 6, and 5), median door to recanalization time (94, 76, and 90 min), median onset to recanalization time (326, 350, and 399 min), complete recanalization (TICI 2b/3: 38, 30, and 24), and median onset to recanalization time (326, 350, and 399 min) did not differ significantly among the three groups. However, the APS4 group had a lower favorable outcome rate (mRS 0-2 at 3 months: 25%, 21%, and 7.8%) and a higher cerebral herniation rate (6.3%, 5.1%, and 18%). Conclusions: Caution is required regarding the indication for endovascular thrombectomy in stroke patients with ASPECTS≤4 because these patients may have a lower favorable outcome rate and a higher rate of cerebral herniation.