Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy

J. T. Kim, B. H. Cho, K. H. Choi, M. S. Park, B. J. Kim, J. M. Park, K. Kang, S. J. Lee, J. G. Kim, J. K. Cha, D. H. Kim, H. W. Nah, T. H. Park, S. S. Park, K. B. Lee, J. Lee, K. S. Hong, Y. J. Cho, H. K. Park, B. C. LeeK. H. Yu, M. S. Oh, D. E. Kim, W. S. Ryu, J. C. Choi, J. H. Kwon, W. J. Kim, D. I. Shin, S. I. Sohn, J. H. Hong, J. S. Lee, J. Lee, H. J. Bae, J. L. Saver, K. H. Cho

Research output: Contribution to journalArticle

Abstract

Background and purpose: The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. Methods: This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. Results: Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15). Conclusions: Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.

Original languageEnglish
Pages (from-to)343-351
Number of pages9
JournalEuropean Journal of Neurology
Volume27
Issue number2
DOIs
StatePublished - 1 Feb 2020

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Alberta
Groin
Punctures
Stroke
Tomography
Therapeutics
Diffusion Magnetic Resonance Imaging
Registries

Keywords

  • DWI-ASPECTS
  • acute ischaemic stroke
  • endovascular therapy
  • time to treatment

Cite this

Kim, J. T. ; Cho, B. H. ; Choi, K. H. ; Park, M. S. ; Kim, B. J. ; Park, J. M. ; Kang, K. ; Lee, S. J. ; Kim, J. G. ; Cha, J. K. ; Kim, D. H. ; Nah, H. W. ; Park, T. H. ; Park, S. S. ; Lee, K. B. ; Lee, J. ; Hong, K. S. ; Cho, Y. J. ; Park, H. K. ; Lee, B. C. ; Yu, K. H. ; Oh, M. S. ; Kim, D. E. ; Ryu, W. S. ; Choi, J. C. ; Kwon, J. H. ; Kim, W. J. ; Shin, D. I. ; Sohn, S. I. ; Hong, J. H. ; Lee, J. S. ; Lee, J. ; Bae, H. J. ; Saver, J. L. ; Cho, K. H. / Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy. In: European Journal of Neurology. 2020 ; Vol. 27, No. 2. pp. 343-351.
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abstract = "Background and purpose: The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. Methods: This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. Results: Ultimately, 985 patients (age 69 ± 11 years; male 55{\%}) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60-min delay in OTP was associated with a 16{\%} reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15). Conclusions: Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.",
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author = "Kim, {J. T.} and Cho, {B. H.} and Choi, {K. H.} and Park, {M. S.} and Kim, {B. J.} and Park, {J. M.} and K. Kang and Lee, {S. J.} and Kim, {J. G.} and Cha, {J. K.} and Kim, {D. H.} and Nah, {H. W.} and Park, {T. H.} and Park, {S. S.} and Lee, {K. B.} and J. Lee and Hong, {K. S.} and Cho, {Y. J.} and Park, {H. K.} and Lee, {B. C.} and Yu, {K. H.} and Oh, {M. S.} and Kim, {D. E.} and Ryu, {W. S.} and Choi, {J. C.} and Kwon, {J. H.} and Kim, {W. J.} and Shin, {D. I.} and Sohn, {S. I.} and Hong, {J. H.} and Lee, {J. S.} and J. Lee and Bae, {H. J.} and Saver, {J. L.} and Cho, {K. H.}",
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Kim, JT, Cho, BH, Choi, KH, Park, MS, Kim, BJ, Park, JM, Kang, K, Lee, SJ, Kim, JG, Cha, JK, Kim, DH, Nah, HW, Park, TH, Park, SS, Lee, KB, Lee, J, Hong, KS, Cho, YJ, Park, HK, Lee, BC, Yu, KH, Oh, MS, Kim, DE, Ryu, WS, Choi, JC, Kwon, JH, Kim, WJ, Shin, DI, Sohn, SI, Hong, JH, Lee, JS, Lee, J, Bae, HJ, Saver, JL & Cho, KH 2020, 'Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy', European Journal of Neurology, vol. 27, no. 2, pp. 343-351. https://doi.org/10.1111/ene.14083

Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy. / Kim, J. T.; Cho, B. H.; Choi, K. H.; Park, M. S.; Kim, B. J.; Park, J. M.; Kang, K.; Lee, S. J.; Kim, J. G.; Cha, J. K.; Kim, D. H.; Nah, H. W.; Park, T. H.; Park, S. S.; Lee, K. B.; Lee, J.; Hong, K. S.; Cho, Y. J.; Park, H. K.; Lee, B. C.; Yu, K. H.; Oh, M. S.; Kim, D. E.; Ryu, W. S.; Choi, J. C.; Kwon, J. H.; Kim, W. J.; Shin, D. I.; Sohn, S. I.; Hong, J. H.; Lee, J. S.; Lee, J.; Bae, H. J.; Saver, J. L.; Cho, K. H.

In: European Journal of Neurology, Vol. 27, No. 2, 01.02.2020, p. 343-351.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy

AU - Kim, J. T.

AU - Cho, B. H.

AU - Choi, K. H.

AU - Park, M. S.

AU - Kim, B. J.

AU - Park, J. M.

AU - Kang, K.

AU - Lee, S. J.

AU - Kim, J. G.

AU - Cha, J. K.

AU - Kim, D. H.

AU - Nah, H. W.

AU - Park, T. H.

AU - Park, S. S.

AU - Lee, K. B.

AU - Lee, J.

AU - Hong, K. S.

AU - Cho, Y. J.

AU - Park, H. K.

AU - Lee, B. C.

AU - Yu, K. H.

AU - Oh, M. S.

AU - Kim, D. E.

AU - Ryu, W. S.

AU - Choi, J. C.

AU - Kwon, J. H.

AU - Kim, W. J.

AU - Shin, D. I.

AU - Sohn, S. I.

AU - Hong, J. H.

AU - Lee, J. S.

AU - Lee, J.

AU - Bae, H. J.

AU - Saver, J. L.

AU - Cho, K. H.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Background and purpose: The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. Methods: This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. Results: Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15). Conclusions: Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.

AB - Background and purpose: The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. Methods: This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8–10), moderate (5–7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0–2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. Results: Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity = 0.15). Conclusions: Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.

KW - DWI-ASPECTS

KW - acute ischaemic stroke

KW - endovascular therapy

KW - time to treatment

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U2 - 10.1111/ene.14083

DO - 10.1111/ene.14083

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VL - 27

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EP - 351

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

IS - 2

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