Study Supports Endovascular Therapy in LVOS with ASPECTS 5-7

November 4, 2015—In Interventional Neurology, Alireza Noorian, MD, et al recently published findings from an investigational intra-arterial therapy (IAT) for large vessel occlusion strokes (LVOS) in patients with midrange Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 5 to 7 (2015;4:30–37). The investigators noted that although IAT has been increasingly utilized to treat LVOS, the benefit of this treatment in patients with midrange ASPECTS remains to be established. 

As summarized in Interventional Neurology, this retrospective analysis of LVOS with ASPECTS 5 to 7 evaluated IAT (n = 86) or medical therapy alone (intravenous tissue plasminogen activator; n = 15) at two centers from 2009 to 2012. In the analysis, symptomatic intracranial hemorrhage was defined as any parenchymal hematoma; successful reperfusion was defined as modified thrombolysis in cerebral infarction score of ≥ 2b; good and acceptable outcomes were defined as 90-day modified Rankin Score of 0–2 and 0–3, respectively. Final infarct volumes (FIV) were calculated based on 24-hour CT/MRI scans. 

The investigators reported that the mean age (67 ± 14 vs 67 ± 19 years) and baseline National Institutes of Health Stroke Score (20 ± 5 vs 20 ± 6) were similar in the IAT and medical therapy alone groups. Successful reperfusion was achieved in 58 (67%) IAT patients. Symptomatic and asymptomatic intracranial hemorrhage occurred in nine (10%) and 31 (36%) IAT patients, respectively. The proportion of 90-day good and acceptable outcomes was 20% (17/86) and 33% (28/86), respectively. 

The investigators found that successful IAT reperfusion was associated with smaller FIV (P = .015) and higher rates of good (P = .01) and acceptable (P = .014) outcomes. There was a strong trend toward a higher hemicraniectomy requirement in medically as compared to endovascularly treated patients (20% vs 6%; P = .06) despite similar in-hospital mortality. Finally, the median FIV was significantly lower with IAT versus medical therapy [80 mL (interquartile range, 38–122 mL) vs 190 mL [interquartile range, 121–267 mL]; P = .015). 

Despite a relatively low probability of achieving functional independence, IAT in LVOS patients with ASPECTS 5 to 7 appears to result in a lower degree of disability and may lessen the need for hemicraniectomy; therefore, it may be a reasonable option for patients and families who favor a shift from severe to moderate disability, concluded the investigators in Interventional Neurology.