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KMID : 1142120230250030388
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Journal of Stroke
2023 Volume.25 No. 3 p.388 ~ p.398
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Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT
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Fumihiro Sakakibara
Kazutaka Uchida
Shinichi Yoshimura
Nobuyuki Sakai
Hiroshi Yamagami
Kazunori Toyoda
Yuji Matsumaru
Yasushi Matsumoto
Kazumi Kimura
Reiichi Ishikura
Manabu Inoue
Noh Hee-Min
Atsushi Yoshida
Kanta Tanaka
Takeshi Yoshimoto
Ryu Do-Jin
Mikiya Beppu
Manabu Shirakawa
Takeshi Morimoto
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Abstract
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Background and Purpose : Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core.
Methods : The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan-Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3-5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum.
Results : Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65-2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46-16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008).
Conclusion : Patients with ASPECTS of 3-5 on MRI benefitted more from EVT than those with ASPECTS of 3-5 on CT.
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KEYWORD
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Acute ischemic stroke, Neuroimaging, Endovascular therapy, Large ischemic core, Large vessel occlusion
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