J Stroke.  2023 Sep;25(3):388-398. 10.5853/jos.2023.01641.

Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT

• Sakakibara F
• Uchida K
• Yoshimura S
• Sakai N
• Yamagami H
• Toyoda K
• Matsumaru Y
• Matsumoto Y
• Kimura K
• Ishikura R
• Inoue M
• Ando K
• Yoshida A
• Tanaka K
• Yoshimoto T
• Koge J
• Beppu M
• Shirakawa M
• Morimoto T
• for the RESCUE-Japan LIMIT Investigators

• KMID: 2546440
• DOI: http://doi.org/10.5853/jos.2023.01641

Abstract

Background and Purpose
Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core.
Methods
The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum.
Results
Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008).
Conclusion
Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.

Keyword

Acute ischemic stroke; Neuroimaging; Endovascular therapy; Large ischemic core; Large vessel occlusion

Figure

• 

  Figure 1. Study flowchart. RESCUE-Japan LIMIT, Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial; MRI, magnetic resonance imaging; mRS, modified Rankin Scale; ICA, internal carotid artery; M1, M1 segment of the middle cerebral artery; ASPECTS, Alberta Stroke Program Early Computed Tomographic Score; NCCT, non-contrast computed tomography; DWI-MRI, diffusion-weighted magnetic resonance imaging; EVT, endovascular therapy.

• 

  Figure 2. Distribution of mRS score at 90 days. (A) ASPECTS based on NCCT. (B) ASPECTS based on DWI-MRI. mRS, modified Rankin Scale; ASPECTS, Alberta Stroke Program Early Computed Tomographic Score; NCCT, non-contrast computed tomography; DWI-MRI, diffusion-weighted magnetic resonance imaging; EVT, endovascular therapy.

Reference

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