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Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients
The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blind...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Japan Neurosurgical Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5929913/ https://www.ncbi.nlm.nih.gov/pubmed/29479041 http://dx.doi.org/10.2176/nmc.oa.2017-0203 |
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author | OHTA, Tsuyoshi MORIMOTO, Masanori OKADA, Kenji FUKUDA, Maki ONISHI, Hirokazu MASAHIRA, Noritaka MATSUOKA, Toshiki TSUNO, Takaya TAKEMURA, Mitsuhiro |
author_facet | OHTA, Tsuyoshi MORIMOTO, Masanori OKADA, Kenji FUKUDA, Maki ONISHI, Hirokazu MASAHIRA, Noritaka MATSUOKA, Toshiki TSUNO, Takaya TAKEMURA, Mitsuhiro |
author_sort | OHTA, Tsuyoshi |
collection | PubMed |
description | The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blinded, cohort study. From September 2012 to August 2016, 83 consecutive patients of acute anterior circulation occlusion were treated with thrombectomy using second-generation devices or medical management. The DWI-ASPECTS was scored after the first MRI. Patient characteristics and clinical outcomes were compared between the treatment groups. Significant dependence was defined as a modified Rankin scale score ≥3 at 90 days. As a result, 33 patients underwent mechanical thrombectomy and 50 received medical management. In the mechanical thrombectomy group, the variable of lower DWI-ASPECTS (5, 4–6 vs. 8, 7–8, P < 0.001), especially ≤6, was significantly associated with poor prognosis. However, compared with patients of DWI-ASPECTS ≤ 6 who received medical management, there were significantly fewer patients with poor outcomes in thrombectomy (dependent in 11 of 15 vs. 23 of 23, respectively; P = 0.019). Although patients with lower pretreatment DWI-ASPECTS could benefit less from thrombectomy, their outcomes were still better than medical management. Therefore, mechanical thrombectomy could be considered in some patients with low pretreatment DWI-ASPECTS. |
format | Online Article Text |
id | pubmed-5929913 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | The Japan Neurosurgical Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-59299132018-05-03 Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients OHTA, Tsuyoshi MORIMOTO, Masanori OKADA, Kenji FUKUDA, Maki ONISHI, Hirokazu MASAHIRA, Noritaka MATSUOKA, Toshiki TSUNO, Takaya TAKEMURA, Mitsuhiro Neurol Med Chir (Tokyo) Original Article The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blinded, cohort study. From September 2012 to August 2016, 83 consecutive patients of acute anterior circulation occlusion were treated with thrombectomy using second-generation devices or medical management. The DWI-ASPECTS was scored after the first MRI. Patient characteristics and clinical outcomes were compared between the treatment groups. Significant dependence was defined as a modified Rankin scale score ≥3 at 90 days. As a result, 33 patients underwent mechanical thrombectomy and 50 received medical management. In the mechanical thrombectomy group, the variable of lower DWI-ASPECTS (5, 4–6 vs. 8, 7–8, P < 0.001), especially ≤6, was significantly associated with poor prognosis. However, compared with patients of DWI-ASPECTS ≤ 6 who received medical management, there were significantly fewer patients with poor outcomes in thrombectomy (dependent in 11 of 15 vs. 23 of 23, respectively; P = 0.019). Although patients with lower pretreatment DWI-ASPECTS could benefit less from thrombectomy, their outcomes were still better than medical management. Therefore, mechanical thrombectomy could be considered in some patients with low pretreatment DWI-ASPECTS. The Japan Neurosurgical Society 2018-04 2018-02-23 /pmc/articles/PMC5929913/ /pubmed/29479041 http://dx.doi.org/10.2176/nmc.oa.2017-0203 Text en © 2018 The Japan Neurosurgical Society This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Original Article OHTA, Tsuyoshi MORIMOTO, Masanori OKADA, Kenji FUKUDA, Maki ONISHI, Hirokazu MASAHIRA, Noritaka MATSUOKA, Toshiki TSUNO, Takaya TAKEMURA, Mitsuhiro Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients |
title | Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients |
title_full | Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients |
title_fullStr | Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients |
title_full_unstemmed | Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients |
title_short | Mechanical Thrombectomy in Anterior Circulation Occlusion Could Be More Effective than Medical Management Even in Low DWI-ASPECTS Patients |
title_sort | mechanical thrombectomy in anterior circulation occlusion could be more effective than medical management even in low dwi-aspects patients |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5929913/ https://www.ncbi.nlm.nih.gov/pubmed/29479041 http://dx.doi.org/10.2176/nmc.oa.2017-0203 |
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