Article Figures & Data
Figures
- Figure 1
New proposed algorithm in AIS workup and treatment. *When IV contrast cannot be used. AIS, acute ischaemic stroke; CTA, CT angiogram; CTH, CT of head; CTP, CT perfusion; IA, intra-arterial; IV, intravenous; IVP, intravenous push; MRA, magnetic resonance angiogram; MRP, magnetic resonance perfusion; MT, mechanical thrombectomy; rt-PA, recombinant tissue plasminogen activator; TICI, thrombolysis in cerebral infarction; TNK, tenecteplase.
Tables
- Table 1
Characteristics and outcome comparison of six trials treating patients with AIS with low ASPECT from an LVO
Trial TENSION RESCUE-Japan LIMIT LASTE TESLA SELECT-2 ANGEL-ASPECT Year started July 2018 November 2018 April 2019 July 2019 October 2019 September 2020 Country European eight countries and Canada Japan USA-Europe USA USA, Canada, Europe, Australia and
New ZealandChina Age (years) >18 >18 ≥18 18–85 18–85 18–80 National Institute of Health Stroke Scale (NIHSS) <26 ≥6 >5 >6 ≥6 6–30 Imaging criteria NCCT or DWI
ASPECT 3–5CT or DWI
ASPECT 3–5NCCT or DWI
ASPECT 0–5NCCT ASPECT 2–5 1. ASPECT >6 and core ≥50 cc
2. ASPECT 3–5 and core ≥50 cc
3. ASPECT 3–5 and core <50 cc1. ASPECT 3–5
2. ASPECT 0–2: 70–100 ccImaging characteristic NCCT ASPECT 82% DWI-ASPECT >90% ASPECT 0–2 56% Only NCCT ASPECT 2–5 ASPECT+Core ASPECT+Core
24 hours, all had NCCTTime window <12 hours LKW <6 hours LKW, 6–24 hours FLAIR (-) <6.5 hours LKW <24 hours <24 hours (0–12 vs 6–24) <24 hours No. of patients enrolled (ITT) 253 (125 vs 128) of 665 planned 202 (100 vs 102),
200 planned324 (165 vs 159) of 450 planned 300 planned 352 (178 vs 174) of 560 planned 455 (230 vs 225) of 502 planned 90-day mRS 0–2 17% vs 2%
7.16 (95% CI 2.12 to 24.21)
P=0.001614.0% vs 7.8% 13.2% vs 4.8% 14.6% vs 8.9% 20.3% vs 7.0%
2.97 (95% CI 1.60 to 5.51)
P<0.000130.0% vs 11.6%
2.62 (95% CI 1.69 to 4.06)
P<0.000190-day mRS 0–3 31% vs 13%
2.84 (95% CI 1.48 to 5.47)
P=0.001831% vs 12.7% 46% vs 12.7% 30% vs 20% 37.9% vs 18.7%
2.06 (95% CI 1.43 to 2.96)
P<0.000147.0% vs 33.3%
1.50 (95% CI 1.17 to 1.91)
P<0.0001sICH 5% vs 5% 9.0% vs 4.9% 9.6% vs 5.7% 3.97% vs 1.34% 0.6% vs 1.1% 6.1% vs 2.7% Death 40% vs 51%
HR 0.67 (95% CI 0.46 to 0.98)
P=0.03818.0% vs 23.5% 55.5% vs 36.1% 35.3% vs 33.3% 38.4% vs 41.5%
Relative Risk (0.91 (95% CI 0.71 to 1.18)21.7% vs 20.0%
HR 1.00 (95% CI 0.65 to 1.54)
P=0.99NNT for functional independence at 90 days (mRS of 0–2) 7 16 12 18 8 5 NNT for independent ambulation at 90 days (mRS of 0–3) 5 5 3 10 5 7 NNH for symptomatic intracranial haemorrhage 143 24 26 38 −200
Negative NNH favours intervention29 ANGEL-ASPECT, Endovascular Therapy for Acute Ischaemic Stroke with Large Infarct; ASPECT, Alberta Stroke Programme Early CT Score; ITT, intention to treat; LASTE, LArge Stroke Therapy Evaluation; LKW, last known well; mRS, modified Rankin Scale; NCCT, non-contrast CT; NNH, number needed to harm; NNT, number needed to treat; RESCUE-Japan LIMIT, Endovascular Therapy for Acute Stroke with a Large Ischaemic Region; SELECT-2, Trial of Endovascular Thrombectomy for Large Ischaemic Strokes; sICH, symptomatic intracranial haemorrhage; TENSION, Endovascular Thrombectomy for Acute Ischaemic Stroke with Established Large Infarct; TESLA, Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischaemic Stroke.
