J Stroke.
2023 Sep;25(3):388-398. 10.5853/jos.2023.01641.
Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT
- Sakakibara F1,2
- Uchida K1,2
- Yoshimura S1
- Sakai N3
- Yamagami H4
- Toyoda K5
- Matsumaru Y6
- Matsumoto Y7
- Kimura K8
- Ishikura R9
- Inoue M5
- Ando K9
- Yoshida A9
- Tanaka K5
- Yoshimoto T5
- Koge J5
- Beppu M1
- Shirakawa M1
- Morimoto T
2 - for the RESCUE-Japan LIMIT Investigators1
- Affiliations
-
- 1Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- 2Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
- 3Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
- 4Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
- 5Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- 6Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- 7Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan
- 8Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- 9Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
- KMID: 2546440
- DOI: http://doi.org/10.5853/jos.2023.01641
Abstract
- 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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