Endovascular therapy in acute ischaemic stroke with large infarction with matched or mismatched clinical-radiological severities: a post-hoc analysis of the ANGEL-ASPECT trial

作者：Lina Zheng, Ximing Nie, Mengxing Wang, Xin Liu, Wanying Duan, Zhe Zhang, Jingyi Liu, Yufei Wei, Miaowen Wen, Zhonghua Yang, Thomas Wai Hong Leung, Gaoting Ma, Xiaochuan Huo, Yuesong Pan, Thanh N. Nguyen, Xinyi Leng, Zhongrong Miao, Liping Liu, Yongjun Wang, Yilong Wang, Liping Liu, David S. Liebeskind, Zhongrong Miao, Zeguang Ren, Vítor Mendes Pereira, Xunming Ji, Qiang Dong, Anding Xu, Xinfeng Liu, Qingwu Yang, Jing Jing, Zhe Zhang, Yingkui Zhang, Wei Wu, Dapeng Sun, Zhongqi Qi, Shuo Li, Zhenqiang Liu, Zequan Yu, Jingyu Zhang, Fangguang Chen, Kangyue Li, Kai Zhang, Mingkai Hu, Jianmin Liu, Chen Yao, Kangning Chen, Kun Fang, Bo Song, Yi Dong, Zhongrong Miao, Xiaochuan Huo, Gaoting Ma, Guangxiong Yuan, Hongxing Han, Wenhuo Chen, Ming Wei, Jiangang Zhang, Zhiming Zhou, Xiaoxi Yao, Guoqing Wang, Weigen Song, Xueli Cai, Guangxian Nan, Di Li, Yizhou Wang, Wentong Ling, Chuwei Cai, Changming Wen, En Wang, Liyong Zhang, Changchun Jiang, Yajie Liu, Geng Liao, Xiaohui Chen, Tianxiao Li, Shudong Liu, Jinglun Li, Yaxuan Sun, Na Xu, Zongen Gao, Dongsheng Ju, Cunfeng Song, Jinggang Xuan, Feng Zhou, Qing Shi, Jun Luo, Yan Liu, Zaiyu Guo, Tong Li, Hongbo Zheng, Linzhi Dai, Junfeng Zhao, Liqiang Gui, Xiaokun Geng, Yufeng Tang, Congguo Yin, Hua Guang Yang, Xiaochuan Huo, Gaoting Ma, Ruiyang An, Yuying Sun, Yanan Wu, Chunlai Yu, Shuangcheng Zheng, Yuesong Pan, Aoming Jin, Xianglong Xiang, Mengxing Wang, Hongyi Yan, Yuanling He, Chunyang Li, Wei-Xia Kong, Yuhuan Chen, Chenhao Guo, Fengjie Ji, Pengshan Ji, Lei Liu, Xinghua Lu, Guangkuo Luo, Nanjing Wang, Yu Zhang, Bo Liu, Jian Can Yang, Jingjing Deng, Juan Wang, Wanru Wang, Hang Yu, Le Cui, Wenwen Liu, Ziyong Wang, Xia Zhao, Zhou Zhou, Zhongrong Miao, Guangxiong Yuan, Hongxing Han, Wenhuo Chen, Ming Wei, Jiangang Zhang, Zhiming Zhou, Xiaoxi Yao, Guoqing Wang, Weigen Song, Xueli Cai, Guangxian Nan, Di Li, Alvin Yi-Chou Wang, Wentong Ling, Chuwei Cai, Changming Wen, En Wang, Liyong Zhang, Changchun Jiang, Yajie Liu, Geng Liao, Xiaohui Chen, Tianxiao Li, Shudong Liu, Jinglun Li, Yaxuan Sun, Na Xu, Zongen Gao, Dongsheng Ju, Cunfeng Song, Jinggang Xuan, Feng Zhou, Qing Shi, Jun Luo, Yan Liu, Zaiyu Guo, Tong Li, Hongbo Zheng, Linzhi Dai, Junfeng Zhao, Liqiang Gui, Xiaokun Geng, Yufeng Tang, Congguo Yin, Hua Guang Yang · 发表于：EClinicalMedicine · 年份：2024 · DOI：10.1016/j.eclinm.2024.102595 · 被引用次数：11 · 研究领域：Acute Ischemic Stroke Management、Antiplatelet Therapy and Cardiovascular Diseases、Neurological Disorders and Treatments

Background: Endovascular therapy (EVT) was demonstrated effective in acute large vessel occlusion (LVO) with large infarction. Revealing subgroups of patients who would or would not benefit from EVT will further inform patient selection for EVT. Methods: This post-hoc analysis of the ANGEL-ASPECT trial, a randomised controlled trial of 456 adult patients with acute anterior-circulation LVO and large infarction, defined by ASPECTS 3-5 or infarct core volume 70-100 mL, enrolled from 46 centres across China, between October 2, 2020 and May 18, 2022. Patients were randomly assigned (1:1) to receiving EVT and medical management or medical management alone. One patient withdrew consent, 455 patients were included in this post-hoc analysis and categorised into 4 subgroups by lower or higher NIHSS (< or ≥16) and smaller or larger infarct core (< or ≥70 mL). Those with lower NIHSS & smaller core, and higher NIHSS & larger core were considered clinical-radiological matched subgroups; otherwise clinical-radiological mismatched subgroups. Primary outcome was 90-day modified Rankin Scale (mRS). ANGEL-ASPECT is registered with ClinicalTrials.gov, NCT04551664. Findings: Overall, 139 (30.5%) patients had lower NIHSS & smaller core, 106 (23.3%) higher NIHSS & larger core, 130 (28.6%) higher NIHSS & smaller core, and 80 (17.6%) lower NIHSS & larger core. There was significant ordinal shift in the 90-day mRS toward a better outcome with EVT in clinical-radiological matched subgroups: lower NIHS...