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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...

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Autores principales: OHTA, Tsuyoshi, MORIMOTO, Masanori, OKADA, Kenji, FUKUDA, Maki, ONISHI, Hirokazu, MASAHIRA, Noritaka, MATSUOKA, Toshiki, TSUNO, Takaya, TAKEMURA, Mitsuhiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 2018
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.
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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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