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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EWhile the Penumbra Pivotal Stroke Trial demonstrated a recanalization rate of 81.6%, the rate of good clinical outcome, defined as a modified Rankin Scale (mRS) score =2, was relatively low (25%) [The Penumbra Pivotal Stroke Investigators. \u003Cem\u003EStroke\u003C\/em\u003E 2009]. This article discusses a subanalysis from the Penumbra Pivotal Stroke Trial, which evaluated whether a good initial noncontrast computed tomography and short time to recanalization predicted good clinical outcome in patients with acute ischemic stroke who were undergoing endovascular procedures.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneuroimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebrovascular disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EWhile the Penumbra Pivotal Stroke Trial demonstrated a recanalization rate of 81.6%, the rate of good clinical outcome, defined as a modified Rankin Scale (mRS) score \u22642, was relatively low (25%) [The Penumbra Pivotal Stroke Investigators. \u003Cem\u003EStroke\u003C\/em\u003E 2009]. Mayank Goyal, MD, University of Calgary, Calgary, Alberta, Canada, presented a subanalysis from the Penumbra Pivotal Stroke Trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe aim of this substudy was to evaluate whether a good initial noncontrast computed tomography (NCCT), defined as \u0026gt;7 according to the ASPECTS scoring system, and short time to recanalization predicted good clinical outcome in patients with acute ischemic stroke who were undergoing endovascular procedures. The substudy included 85 of the original 125 Penumbra trial participants (median age 64.1 years), stratified by blinded NCCT reading at presentation. Patients were grouped according to NCCT ASPECTS score of \u0026gt;7 or \u22647 (median ASPECTS score at baseline was 6). ASPECTS scores were categorized as good (8 to 10; observed in 36.5% of patients), intermediate (5 to 7), and poor (0 to 4). The primary outcome was mRS \u22642 at 3 months.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EMedical comorbidities at baseline included hypertension (n=83), diabetes (n=23), and atrial fibrillation (n=34). Occlusions were located in the internal carotid artery in 22.4% of patients (19.3% had ASPECTS scores \u0026gt;7 vs 24.1% \u22647), in the M1 main coronary artery in 63.5% of patients (61.3% had ASPECTS scores \u0026gt;7 vs 64.8% \u22647), and in the M2 main carotid artery in 14.1% of patients (19.3% had ASPECTS scores \u0026gt;7 vs 11.1% \u22647) at baseline.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ETIMI scores of 2 to 3 were noted in 81.2% of patients. Of the patients with ASPECTS scores \u0026gt;7, 83.9% had TIMI 2 to 3 recanalization compared with 79.6% with ASPECTS scores \u22647 (p= 0.8). At 3 months, mRS 0 to 2 was observed in 27.1% of patients, 50% in the ASPECTS scores \u0026gt;7 group, and 15% in the ASPECTS scores \u2264 7 group (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). When broken down by ASPECTS categories of good, intermediate, and poor, good clinical outcome was significantly greater in the \u0026gt;7 group compared with the \u22647 group (RR 3.3; 95% CI, 1.6 to 6.8; \u003Ca id=\u0022xref-table-wrap-1-2\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E), and no patient with an ASPECTS score \u22644 (poor scan, n=28) had good clinical outcome. Additionally, good clinical outcome was significantly higher in the early recanalizer (\u2264300 minutes) group compared with the combined late recanalizer (\u0026gt;300 minutes) or nonrecanalizer (TIMI 0 to 1) group (RR 2.3; 95% CI, 1.2 to 4.4). No patient without recanalization (TIMI 0 to 1; n=16) did well.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11225\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11225\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11225\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EClinical Outcomes Stratified by Baseline CT ASPECTS Score.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EAfter adjusting for baseline stroke severity, there was evidence of an ASPECTS score and onset-to-recanalization time interaction. The direction of interaction was such that among patients with ASPECTS scores \u0026gt;7, the relative effect of onset-to-recanalization time (\u2264300 minutes or \u0026gt;300 minutes) in predicting outcome was small. Among patients with ASPECTS scores \u22647, only those with an onset-to-recanalization time \u2264 300 minutes had some chance of achieving a functional outcome (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/1\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Clinical Outcome (mRS at 3 months) in Two Groups, ASPECTS Scores \u0026amp;gt;7 and \u0026#x2264;7, Stratified By Onset-to-Recanalization Time \u0026amp;lt;300 Minutes and \u0026#x2265;300 Minutes.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-393799262\u0022 data-figure-caption=\u0022Clinical Outcome (mRS at 3 months) in Two Groups, ASPECTS Scores \u0026amp;amp;gt;7 and \u0026#x2264;7, Stratified By Onset-to-Recanalization Time \u0026amp;amp;lt;300 Minutes and \u0026#x2265;300 Minutes.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1:\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/1\/21\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/1\/21\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1:\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/1\/21\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11222\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1:\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EClinical Outcome (mRS at 3 months) in Two Groups, ASPECTS Scores \u0026gt;7 and \u22647, Stratified By Onset-to-Recanalization Time \u0026lt;300 Minutes and \u2265300 Minutes.\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from M. Goyal, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EDr. Goyal concluded that faster recanalization and proper patient selection that is based on initial NCCT contribute to the achievement of good clinical outcomes in patients with acute ischemic stroke who undergo endovascular procedures.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/1\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmua1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmua1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmua1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}