Impact of Age and ASPECTS 0-5 on Mechanical Thrombectomy Outcomes: Analysis from the STRATIS Registry

Abstract

Background: This study investigates clinical outcomes after mechanical thrombectomy (MT) in adult patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) of 0–5.Methods: We included data from the STRATIS Registry from patients who underwent MT within eight hours of symptom onset and had available ASPECTS data adjudicated by an independent core laboratory. Angiographic and clinical outcomes were collected, including successful reperfusion (modified thrombolysis in cerebral infarction [mTICI] ≥2b), functional independence (modified Rankin Scale [mRS] 0–2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH) at 24 hours. Outcomes were stratified by ASPECTS scores and age.Findings: Of the 984 patients enrolled, 763 had available ASPECTS data. Of these patients, 57 had ASPECTS of 0–5 with a median age of 63 years (IQR 28, 100), while 706 patients had ASPECTS 6-10 with a median age of 70 years of age (IQR 19, 100). Ten patients had ASPECTS 0–3 and 47 patients had ASPECTS 4–5 at baseline. Successful reperfusion was achieved in 85.5% (47/55) in the ASPECTS 0–5 group. Functional independence was achieved in 28·8% (15/52) in the ASPECTS 0–5 versus 59·7% (388/650) in the 6–10 group (p75 years with ASPECTS 0–5 (0/12) achieved functional independence versus 44·8% (13/29) of those age ≤65 (p=0·005).Interpretation: Patients ≤65 years of age with large core infarction (ASPECTS 0–5) have better rates of functional independence and lower rates of mortality compared to patients >75 years of age.Clinical Trial Registration: https://www.clinicaltrials.gov. Unique identifier: NCT02239640.Funding Statement: This study was sponsored by Medtronic, Inc.Declaration of Interests: OOZ serves as a consultant for Neuravi, Stryker, Penumbra, and Medtronic. DL serves as a consultant for Cerenovus, Genentech, Medtronic, Stryker, and Vesalio. SO-G serves as a consultant for Medtronic and Stryker Neurovascular. TN is the Principal Investigator of the CLEAR study (CT for Late Endovascular Reperfusion) funded by Medtronic; serves on the Data Safety Monitoring Board for TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke), ENDOLOW (Endovascular Therapy for Low NIHSS Ishemic Strokes), SELECT 2 (A Randomized Controlled Trial to Optimize Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke) trials. DCH serves as a consultant for Stryker, Vesalio and Cerenovus; has stock options with VizAi. AEH is a consultant and speaker for Medtronic, Stryker, Microvention, Penumbra, Balt, Viz Ai, Scientia, Genentech, and GE Healthcare; received personal fees with Cerenovus outside of submitted work. DRY serves as a consultant for Medtronic, Cerenovus, Rapid Medical, Vascular Dynamics, scientific advisory board member for Poseydon, Neurosave, and Neuralanalytics. MTF serves as a scientific consultant to Medtronic, Stryker, Balt USA, Viz.ai, Corindus, and Genentech, and has received research funding from the National Institutes of Health (NIH), Stryker, Medtronic, Microvention, and Genentech. The University of California, Regents receives funding for RJ’s services as a scientific consultant regarding trial design and conduct to Medtronic/Covidien; he is an employee of the University of California, which holds a patent on retriever devices for stroke. Medina Medical, consultant. RGN has served as an advisor or consultant for Cerenovus/Neuravi, Phenox, Stryker Neurovascular and owns stock, stock options, or bonds from Cerenovus/Neuravi, Phenox, and Stryker Neurovascular. TLY serves as consultant/proctor for Medtronic. NHM-K serves as scientific consultants regarding trial design and conduct to Medtronic. The remaining authors have nothing to disclose. Ethics Approval Statement: Ethic committees and institutional review boards approval was obtained at each medical center. Subjects were provided a written informed consent prior to enrollment.