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

作者：Xiaochuan Huo, Thanh N. Nguyen, Dapeng Sun, ­ Raynald, Yuesong Pan, Gaoting Ma, Xu Tong, Mengxing Wang, Ning Ma, Feng Gao, Dapeng Mo, Mohamad Abdalkader, Hesham Masoud, Raul G. Nogueira, Zhongrong Miao, for the ANGEL‐ASPECT study group · 发表于：Annals of Neurology · 年份：2024 · DOI：10.1002/ana.27017 · 被引用次数：18 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Coronary Interventions and Diagnostics

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...