Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

Johanna Ospel; Manon Kappelhof; Adrien E Groot; Natalie E LeCouffe; Jonathan M Coutinho; Albert J Yoo; Lonneke S F Yo; Ludo F M Beenen; Wim H van Zwam; Aad van der Lugt; Alida A Postma; Yvo B W E M Roos; Mayank Goyal; Charles B L M Majoie; MR CLEAN Registry Investigators†

doi:10.1161/STROKEAHA.120.031773

Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

Stroke. 2020 Dec;51(12):3742-3745. doi: 10.1161/STROKEAHA.120.031773. Epub 2020 Oct 23.

Authors

Johanna Ospel^#^{1

2}, Manon Kappelhof^#³, Adrien E Groot⁴, Natalie E LeCouffe⁴, Jonathan M Coutinho⁴, Albert J Yoo⁵, Lonneke S F Yo⁶, Ludo F M Beenen³, Wim H van Zwam⁷, Aad van der Lugt⁸, Alida A Postma⁷, Yvo B W E M Roos⁴, Mayank Goyal^{1

9}, Charles B L M Majoie³; MR CLEAN Registry Investigators†

Collaborators

MR CLEAN Registry Investigators†:
Diederik W J Dippel, Robert J van Oostenbrugge, Jelis Boiten, Jan Albert Vos, Ivo G H Jansen, Maxim J H L Mulder, Robert-Jan B Goldhoorn, Kars C J Compagne, Josje Brouwer, Sanne J den Hartog, Wouter H Hinsenveld, Bob Roozenbeek, Adriaan C G M van Es, Bart J Emmer, Wouter J Schonewille, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M Martens, Geert J Lycklama À Nijeholt, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, J de Vries, Paul L M de Kort, Julia van Tuijl, Jo P Peluso, Puck Fransen, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P H Bokkers, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Heleen M den Hertog, Emiel J C Sturm, Paul J A M Brouwers, Marieke E S Sprengers, Sjoerd F M Jenniskens, René van den Berg, Stefan D Roosendaal, Bas F W van der Kallen, Ido R van den Wijngaard, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Reinoud P H Bokkers, Marc P van Proosdij, G Menno Krietemeijer, Jo P Peluso, Rob Lo, Dick Gerrits, Wouter Dinkelaar, Auke P A Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, Robert J van Oostenbrugge, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger R M Harmsma, Daan Muijres, Anouk de Jong, Olvert A Berkhemer, Anna M M Boers, J Huguet, P F C Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon L Tolhuisen, Heitor Alves, Annick J Weterings, Eleonora L F Kirkels, Lieve M Schupp, Eva J H F Voogd, Sabine Collette, Praneeta R Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A Ramos

Affiliations

¹ Clinical Neurosciences (J.O., M.G.), University of Calgary, Alberta, Canada.
² Neuroradiology, University Hospital Basel, Switzerland (J.O.).
³ Radiology & Nuclear Medicine (M.K., L.F.M.B., C.B.L.M.M.), Amsterdam UMC, University of Amsterdam, the Netherlands.
⁴ Neurology (A.E.G., N.E.L., J.M.C., Y.B.W.E.M.R.), Amsterdam UMC, University of Amsterdam, the Netherlands.
⁵ Radiology, Texas Stroke Institute, Dallas (A.J.Y.).
⁶ Radiology, Catharina Hospital, Eindhoven, the Netherlands (L.S.F.Y.).
⁷ Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, School for Mental Health and Sciences, Maastricht University Medical Center, the Netherlands (W.H.v.Z., A.A.P.).
⁸ Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands (A.v.d.L.).
⁹ Diagnostic Imaging (M.G.), University of Calgary, Alberta, Canada.

^# Contributed equally.

PMID: 33092478
DOI: 10.1161/STROKEAHA.120.031773

Abstract

Background and purpose: Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups.

Methods: Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014-November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (age×ASPECTS). Outcomes in four patient subgroups based on age (< versus ≥ median age [71.8 years]) and baseline ASPECTS (6-10 versus 0-5) were assessed.

Results: We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale (P=0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66-3.88], n=110), there was no significant difference from the main effect (P=0.299).

Conclusions: Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.

Keywords: odds ratio; registries; reperfusion; thrombectomy; tomography.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Aged, 80 and over
Endovascular Procedures*
Female
Humans
Ischemic Stroke / diagnostic imaging
Ischemic Stroke / physiopathology
Ischemic Stroke / surgery*
Logistic Models
Male
Middle Aged
Multivariate Analysis
Prognosis
Registries
Severity of Illness Index
Thrombectomy*
Tomography, X-Ray Computed