Association of Mismatch Profiles and Clinical Outcome from Endovascular Therapy in Large Infarct: A Post-Hoc Analysis of the ANGEL-ASPECT Trial

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2024-07-02 DOI:10.1002/ana.27017

Xiaochuan Huo MD, Thanh N Nguyen MD, Dapeng Sun MD, PhD, Raynald MD, Yuesong Pan PhD, Gaoting Ma MD, Xu Tong MD, Mengxing Wang PhD, Ning Ma MD, Feng Gao MD, Dapeng Mo MD, Mohamad Abdalkader MD, Hesham E. Masoud MD, Raul G. Nogueira MD, Zhongrong Miao MD, for the ANGEL-ASPECT study group

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Abstract

Objectives

We investigated whether patients with large infarct and the presence or absence of perfusion mismatch are associated with endovascular treatment benefit.

Methods

This is a post-hoc analysis of the Endovascular Therapy in Anterior Circulation Large Vessel Occlusion with a Large Infarct (ANGEL-ASPECT) randomized trial, which enrolled patients within 24 hours of onset with ASPECTS 3 to 5 or ASPECTS 0 to 2 with an infarct core 70 to 100 ml. Mismatch ratio was defined as time-to-maximum (T_max) >6 s cerebral volume/ischemic core volume, and mismatch volume was defined as T_max >6 s volume minus ischemic core volume. We divided patients into mismatch ratio ≥1.2 and mismatch volume ≥10 ml, and mismatch ratio ≥1.8 and mismatch volume ≥15 ml groups. The primary outcome was the 90-day modified Rankin Scale score ordinal distribution. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality.

Results

There were 425 patients included. In both the mismatch ratio ≥1.2 and mismatch volume ≥10 ml (mismatch+, n = 395; mismatch−, n = 31) and mismatch ratio ≥1.8 and mismatch volume ≥15 ml groups (mismatch+, n = 346; mismatch−, n = 80), better 90-day modified Rankin Scale outcomes were found in the endovascular treatment group compared with the MM group (4 [2–5] vs 4 [3–5], common odds ratio [cOR], 1.9, 95% confidence interval [CI] 1.3–2.7, p = 0.001; 4 [2–5] vs 4 [3–5], cOR, 1.9, 95% CI 1.3–2.8, p = 0.001, respectively), but not in patients without mismatch ratio ≥1.2 and mismatch volume ≥10 ml (5 [3–6] vs 5 [4–6], cOR, 1.2, 95% CI 0.3–4.1, p = 0.83), and mismatch ratio ≥1.8 and mismatch volume ≥15 ml (4 [3–6] vs 5 [3–6], cOR, 1.2, 95% CI 0.6–2.7, p = 0.60). However, no interaction effect was found in both subgroups (p interaction >0.10).

Conclusion

Endovascular treatment was more efficacious than MM in patients with mismatch profiles, but no treatment effect or interaction was noted in the no mismatch profile patients. However, the small sample size of patients with no mismatch may have underpowered our analysis. A pooled analysis of large core trials stratified by mismatch is warranted. ANN NEUROL 2024;96:729–738

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大面积脑梗死血管内治疗的错配特征与临床结果的关系：ANGEL-ASPECT 试验的事后分析。

目的我们研究了大面积梗死患者以及灌注不匹配的存在与否是否与血管内治疗获益有关：这是对大面积梗死前循环大血管闭塞的血管内治疗（ANGEL-ASPECT）随机试验的事后分析，该试验招募了发病 24 小时内 ASPECTS 3 至 5 或 ASPECTS 0 至 2 且梗死核心 70 至 100 毫升的患者。错配比率的定义是最大时间（Tmax）大于 6 秒的脑容量/缺血核心容积，错配容积的定义是 Tmax 大于 6 秒的容积减去缺血核心容积。我们将患者分为错配比率≥1.2 和错配体积≥10 ml 组，以及错配比率≥1.8 和错配体积≥15 ml 组。主要结果是90天改良Rankin量表评分的顺序分布。安全性结果为无症状性颅内出血和90天死亡率：结果：共纳入 425 名患者。在错配比率≥1.2和错配容积≥10 ml组（错配+，n = 395；错配-，n = 31）和错配比率≥1.8和错配容积≥15 ml组（错配+，n = 346；错配-，n = 80）中，发现血管内治疗组的90天改良Rankin量表结果优于MM组（4 [2-5] vs 4 [3-5]，常见几率比[cOR]，1.9, 95% confidence interval [CI] 1.3-2.7, p = 0.001; 4 [2-5] vs 4 [3-5], cOR, 1.9, 95% CI 1.3-2.8, p = 0.001)，但在错配比≥1.2 和错配体积≥10 ml 的患者（5 [3-6] vs 5 [4-6]，cOR，1.2，95% CI 0.3-4.1，p = 0.83），以及错配比率≥1.8 和错配体积≥15 ml 的患者（4 [3-6] vs 5 [3-6]，cOR，1.2，95% CI 0.6-2.7，p = 0.60）。然而，在两个亚组中均未发现交互作用（交互作用 p >0.10）：结论：在有错配特征的患者中，血管内治疗比MM更有效，但在无错配特征的患者中未发现治疗效果或交互作用。结论：血管内治疗比MM更有效，但在无错配特征的患者中未发现治疗效果或交互作用。然而，无错配特征患者的样本量较小，可能削弱了我们的分析能力。有必要对按错配分层的大型核心试验进行汇总分析。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.

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