Neurovascular Imaging Research Core, UCLA, Los Angeles, CA (D.S.L., H.S.).
Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.).
Stroke. 2021 Oct;52(10):3318-3324. doi: 10.1161/STROKEAHA.120.033477. Epub 2021 Jul 20.
The impact of baseline ischemia on Alberta Stroke Program Early CT Score (ASPECTS) and evolution over 24 hours may be distinct in late thrombectomy. We analyzed predictors of serial ASPECTS and clinical outcomes in the DAWN trial (Diffusion-Weighted Imaging or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo).
The DAWN Imaging Core Laboratory independently scored ASPECTS at baseline and 24 hours. Descriptive statistics characterized ASPECTS on computed tomography/magnetic resonance imaging at baseline and 24 hours, delineating ASPECTS change over 24 hours.
206 subjects (mean age 70.0±13.7 years; 54.9% (n=113) female; baseline National Institutes of Health Stroke Scale median (interquartile range) 17 (13, 21) were included. Baseline ASPECTS was median (interquartile range) 8.0 (7–8), with 92/205 (44.9%) between 0 and 7 and 113/205 (55.1%) 8 and 10. 24-hour ASPECTS was median 6.0 (4–8), with ASPECTS change or infarct evolution having median −1, ranging from −8 to +2. Multivariable logistic regression showed older age (odds ratio [OR] for 10-year interval, 1.26 [95% CI, 1.02–1.55], P=0.030) and dyslipidemia (OR, 1.84 [95% CI, 1.06–3.19], P=0.031) were independently associated with higher baseline ASPECTS. Higher 24-hour ASPECTS was predicted by endovascular treatment (OR, 2.76 [95% CI, 1.58–4.81], P=0.0004), baseline glucose <150 mg/dL (OR, 2.86 [95% CI, 1.50–5.46], P=0.001), lower baseline National Institutes of Health Stroke Scale (OR, 0.93 [95% CI, 0.89–0.98], P=0.010), and older age (OR for 10-year interval, 1.25 [95% CI, 1.01–1.55], P=0.041). Internal carotid artery lesion location (OR, 0.47 [95% CI, 0.24–0.89], P=0.021) was inversely related to 24-hour ASPECTS. Good clinical outcome (day 90 modified Rankin Scale score 0–2) was predicted by 24-hour ASPECTS (OR, 1.46 [95% CI, 1.08–1.96], P=0.014). Extensive infarct evolution (ASPECTS decrease ≥6) occurred in 14/201 (7.0%). Elevated baseline serum glucose ≥150 mg/dL was a predictor of ASPECTS decrease of ≥4 points (OR, 2.78 [95% CI, 1.21–6.35] P=0.016) as was internal carotid artery occlusion (OR, 2.49 [95% CI, 1.05–5.88]; P=0.038). ASPECTS change was influenced by treatment arm (P=0.001 by Wilcoxon), including 0 ASPECTS change in 42/105 (40.0%) of the endovascular arm and only 20/96 (20.8%) of the medical arm.
DAWN subjects enrolled with small infarct cores had a broad range of baseline ASPECTS. Twenty-four-hour ASPECTS, strikingly influenced by endovascular therapy, predicted good clinical outcomes.
https://www.clinicaltrials.gov; Unique identifier: NCT02142283.
在晚期取栓中，基线缺血对 Alberta 卒中项目早期 CT 评分（ASPECTS）的影响及其 24 小时的演变可能不同。我们分析了 DAWN 试验（在接受神经介入治疗的觉醒和迟发性卒中患者中，通过弥散加权成像或 CTP 评估与临床不匹配进行的治疗选择）中连续 ASPECTS 和临床结局的预测因素。
DAWN 成像核心实验室独立对基线和 24 小时的 ASPECTS 进行评分。描述性统计分析了 CT 或磁共振成像的基线和 24 小时的 ASPECTS，描述了 24 小时内 ASPECTS 的变化。
206 名受试者（平均年龄 70.0±13.7 岁；54.9%（n=113）为女性；基线国立卫生研究院卒中量表中位数（四分位距）为 17（13，21）。基线 ASPECTS 中位数为 8.0（7-8），92/205（44.9%）为 0-7，113/205（55.1%）为 8-10。24 小时 ASPECTS 中位数为 6.0（4-8），ASPECTS 变化或梗死演变的中位数为-1，范围从-8 到+2。多变量逻辑回归显示，年龄较大（每 10 年间隔的优势比，1.26[95%可信区间，1.02-1.55]，P=0.030）和血脂异常（优势比，1.84[95%可信区间，1.06-3.19]，P=0.031）与较高的基线 ASPECTS 独立相关。较高的 24 小时 ASPECTS 与血管内治疗（优势比，2.76[95%可信区间，1.58-4.81]，P=0.0004）、基线血糖<150mg/dL（优势比，2.86[95%可信区间，1.50-5.46]，P=0.001）、较低的基线国立卫生研究院卒中量表（优势比，0.93[95%可信区间，0.89-0.98]，P=0.010）和年龄较大（每 10 年间隔的优势比，1.25[95%可信区间，1.01-1.55]，P=0.041）有关。颈内动脉病变部位（优势比，0.47[95%可信区间，0.24-0.89]，P=0.021）与 24 小时 ASPECTS 呈负相关。良好的临床结局（90 天改良 Rankin 量表评分 0-2）与 24 小时 ASPECTS（优势比，1.46[95%可信区间，1.08-1.96]，P=0.014）有关。广泛的梗死演变（ASPECTS 下降≥6）发生在 201 例中的 14 例（7.0%）。基线血清葡萄糖升高≥150mg/dL 是 ASPECTS 下降≥4 分的预测因素（优势比，2.78[95%可信区间，1.21-6.35]，P=0.016），颈内动脉闭塞也是如此（优势比，2.49[95%可信区间，1.05-5.88]；P=0.038）。ASPECTS 的变化受到治疗臂的影响（Wilcoxon 检验 P=0.001），其中血管内治疗组的 0 变化为 42/105（40.0%），而药物治疗组的仅为 20/96（20.8%）。
在小梗死核心的 DAWN 受试者中，基线 ASPECTS 范围广泛。24 小时 ASPECTS 受血管内治疗的显著影响，预测良好的临床结局。
