dwi-aspects [Neurosurgery Wiki]

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Cardioembolic [[stroke]] has a poor [[prognosis]]. Oki et al. evaluated the region-dependent [[efficacy]] of [[endovascular therapy]] (EVT) based on [[diffusion-weighted imaging]]-Alberta Stroke Program Early CT Score ([[DWI-ASPECTS]]).

This post-hoc analysis of the [[RELAXED study]], which investigated the optimal timing of [[rivaroxaban]] to prevent nonvalvular [[atrial fibrillation]] (NVAF) recurrence in patients with [[acute ischemic stroke]] (AIS), included NVAF patients admitted with [[AIS]] or [[transient ischemic attack]] in the [[middle cerebral artery]] (MCA), with [[internal carotid artery]] (ICA), M1, or M2-MCA occlusion. Relationships between [[DWI-ASPECTS]] region and [[functional outcome]] ([[modified Rankin Scale]] [mRS]), [[mortality]], [[recurrence]], and [[hemorrhagic stroke]] were compared between patients with and without EVT, and adjusted [[odds ratio]]s for age, pre-stroke mRS, National Institutes of Health Stroke Scale ([[NIHSS]]), ICA occlusion, infarct size, [[recombinant tissue plasminogen activator]] (rt-PA) use, and onset-to-hospitalization time were estimated.

EVT patients had significantly lower [[hemoglobin]] levels, higher median NIHSS scores, more [[lentiform nucleus infarct]]s, ICA or M1-MCA occlusions, treatment with rt-PA, and fewer M3, M5, or M6 infarcts and M2-MCA occlusions than no-EVT patients. EVT patients had shorter onset-to-hospitalization times and more frequent favorable functional outcomes (p=0.007). Mortality, recurrent [[ischemic stroke]], and hemorrhagic infarction were similar in both groups. EVT was associated with significantly better functional outcomes among patients with insular ribbon (p=0.043) and M3 (p=0.0008) infarcts. M3 patients had significantly fewer rt-PA and EVT, and longer onset-to-hospitalization times.

An occlusion in the [[insular ribbon]] or [[M3 region]] was associated with favorable [[functional outcome]]s in patients treated with [[EVT]] after [[cardioembolic stroke]]
((Oki Y, Sakakibara F, Uchida K, Kageyama H, Yasaka M, Toyoda K, Mori E, Hirano T, Hamasaki T, Yamagami H, Nagao T, Uchiyama S, Minematsu K, Yoshimura S; [[RELAXED study]] group. ASPECTS-Region-Dependent Functional Outcomes after Endovascular Therapy in Patients with Cardioembolic Stroke. J Stroke Cerebrovasc Dis. 2021 Apr 26;30(7):105814. doi: 10.1016/j.jstrokecerebrovasdis.2021.105814. Epub ahead of print. PMID: 33915390.)).