ANGEL-ASPECT Post-Hoc (CTP Mismatch)
(2024)Objective
To assess whether the presence of perfusion mismatch modifies the benefit of endovascular treatment (EVT) in patients with large infarcts.
Study Summary
• In the post-hoc analsis, EVT improved outcomes in patients with large infarcts and a mismatch profile (ratio ≥1.2 and volume ≥10 ml or ratio ≥1.8 and volume ≥15 ml), but not in those without mismatch.
Intervention
Endovascular thrombectomy vs. medical management within 24 hours for patients with ASPECTS 3–5 or ASPECTS 0–2 and infarct core 70–100 ml. Perfusion mismatch was defined by two thresholds: • Mismatch ratio = volume of Tmax >6 s region divided by infarct core volume • Mismatch volume = volume of Tmax >6 s region minus infarct core volume
Study Design
Arms: Array
Outcome
• EVT group with mismatch (≥1.2 ratio/≥10 ml volume): mRS 4 [2–5] vs. 4 [3–5], cOR 1.9 (95% CI 1.3–2.7), p=0.001 • EVT group with mismatch (≥1.8 ratio/≥15 ml volume): mRS 4 [2–5] vs. 4 [3–5], cOR 1.9 (95% CI 1.3–2.8), p=0.001 • No significant benefit in patients without mismatch • No significant treatment-by-mismatch interaction (p>0.10) • Safety outcomes: symptomatic ICH and 90-day mortality not specifically reported in abstract