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Ischemic stroke
Original research
Spontaneous recanalization in acute large core ischemic stroke due to large vessel occlusion: a post-hoc analysis of the ANGEL-ASPECT trial
  1. Longhui Zhang1,2,
  2. Fangguang Chen1,2,
  3. Thanh N Nguyen3,
  4. Yuesong Pan1,4,
  5. Yufan Liu4,
  6. Mengxing Wang4,
  7. Shuo Li5,
  8. Dapeng Sun1,2,4,
  9. Xiaochuan Huo5,
  10. BaiXue Jia1,2,4,
  11. Zhongrong Miao1,2,4
  12. The ANGEL-ASPECT Study Group
      1. 1Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
      2. 2Department of Neurology, Capital Medical University, Beijing, China
      3. 3Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
      4. 4China National Clinical Research Centre for Neurological Diseases, Beijing, China
      5. 5Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
      1. Correspondence to Dr Zhongrong Miao; zhongrongm{at}163.com

      Abstract

      Background Previous studies have indicated that a subset of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) experience spontaneous recanalization (SR), but the prognosis and factors associated with SR in these individuals are not well characterized.

      Methods We conducted a post hoc secondary analysis of the Study of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core (ANGEL-ASPECT) trial. SR in the medical management group was defined as a modified arterial occlusive lesion (AOL) grade of 2 or 3 on computed tomography angiography (CTA) or magnetic resonance angiography (MRA) at 36 hours (±12 hours).

      Results SR was detected in 67 out of 184 patients (36.4%) in the medical management (MM) group. The median age of patients was 67 years (interquartile range (IQR) 58–72), and 48 (71.6%) were male. The adjusted odds ratio (aOR) for 90-day modified Rankin Scale (mRS) score shift toward better outcomes of the MM with SR group vs the MM without SR group was 1.83, with marginally significant difference (95% confidence interval (CI) 0.992 to 3.36; P=0.053). No significant difference was found between the MM with SR group and EVT recanalization group (aOR 1.45; 95% CI 0.86 to 2.43; P=0.16) with similar findings in the inverse probability treatment weighting analysis (OR 0.85; 95% CI 0.49 to 1.48; P=0.57). Multivariable regression analysis showed that hypertension, atherothrombotic stroke and higher clot burden score were factors associated with SR.

      Conclusions SR in medically managed patients with acute large ischemic stroke caused by LVO was associated with good functional outcome. An improved understanding of SR patients may be helpful to develop therapeutic strategy in patients with large infarct due to LVO in anterior circulation.

      Trial registration number NCT04551664.

      • Stroke

      Data availability statement

      Data are available upon reasonable request.

      https://doi.org/10.1136/jnis-2024-022357

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        Data availability statement

        Data are available upon reasonable request.

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        Footnotes

        • X @NguyenThanhMD

        • LZ and FC contributed equally.

        • Collaborators The ANGEL-ASPECT Study Group’s full names and academic degrees are as follows: Xiaochuan Huo, M.D., Ph.D., Gaoting Ma, M.D., Ph.D., Xu Tong, M.D., Ph.D., Xuelei Zhang, M.D., Ph.D., Yuesong Pan, Ph.D., Thanh N. Nguyen, M.D., Guangxiong Yuan, M.D., Hongxing Han, Ph.D., Wenhuo Chen, Ph.D., Ming Wei, M.D., Jiangang Zhang, M.D., Zhiming Zhou, M.D., Xiaoxi Yao, B.S., Guoqing Wang, M.D., Weigen Song, B.S., Xueli Cai, Ph.D., Guangxian Nan, M.D., Di Li, M.D., A. Yi-Chou Wang, Ph.D., Wentong Ling, B.S., Chuwei Cai, Ph.D., Changming Wen, Ph.D., En Wang, Ph.D., Liyong Zhang, M.D., Changchun Jiang, Ph.D., Yajie Liu, M.D., Geng Liao, Ph.D., Xiaohui Chen, M.D., Tianxiao Li, M.D., Shudong Liu, M.D., Jinglun Li, M.D., Feng Gao, M.D., Ph.D., Ning Ma, M.D., Ph.D., Dapeng Mo, M.D., Ph.D., Ligang Song, M.D., Xuan Sun, M.D., Ph.D., Xiaoqing Li, M.D., Ph.D., Yiming Deng, M.D., Ph.D., Gang Luo, M.D., Ph.D., Ming Lv, M.D., Hongwei He, M.D., Aihua Liu, M.D., Jingbo Zhang, M.D., Shiqing Mu, M.D., Lian Liu, M.D., Jing Jing, Ph.D., Ximing Nie, M.D., Zeyu Ding, M.D., Wanliang Du, M.D., Xingquan Zhao, M.D., Ph.D., Pengfei Yang, M.D., Ph.D., Liping Liu, M.D., Ph.D., Yilong Wang, M.D., Ph.D., David S. Liebeskind, M.D., Vitor M. Pereira, Ph.D., Zeguang Ren, M.D., Yongjun Wang, M.D., Ph.D., and Zhongrong Miao, M.D., Ph.D.

          The ANGEL-ASPECT Study Group’s affiliations are as follows: Interventional Neuroradiology, Department of Neurology (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, Z.M.), and the Departments of Neurosurgery (M.L., H. He, A.L., Jingbo Zhang, S.M., Lian Liu), and Neurology (J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, and Beijing Institute for Brain Disorders (X. Zhang), Capital Medical University, and China National Clinical Research Center for Neurological Diseases (X.H., G.M., X.T., X. Zhang, Y.P., F.G., N.M., D.M., L.S., X.S., X.L., Y.D., G. Luo, J.J., X.N., Z.D., W.D., X. Zhao, Liping Liu, Yilong Wang, Yongjun Wang, Z.M.), Beijing, the Department of Emergency, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, First People’s Hospital of Chenzhou, Chenzhou (X.Y.), the Department of Neurology, Linyi People’s Hospital, Linyi (H. Han), the Department of Neurology, Binzhou People’s Hospital, Binzhou (G.W.), the Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng (L.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin (M.W.), the Department of Neurology, Anyang People’s Hospital, Anyang (Jiangang Zhang), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), and the Department of Cerebrovascular Disease, Henan Provincial People’s Hospital Zhengzhou University, Zhengzhou (T.L.), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurology, Yancheng Third People’s Hospital, Yancheng (W.S.), the Department of Neurology, Lishui Municipal Central Hospital, Lishui (X. Cai), the Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou (E.W.), the Department of Neurology, China–Japan Union Hospital of Jilin University, Changchun (G.N.), the Department of Neurointervention, Dalian Municipal Central Hospital, Dalian Medical University, Dalian (D.L.), the Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine (A.Y.-C.W.), the Department of Neurology, Zhongshan City People’s Hospital (W.L.), and the Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University (X. Chen), Guangzhou, the Department of Neurology, Shantou Central Hospital, Shantou (C.C.), the Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen (Y.L.), the Department of Neurology, Maoming People’s Hospital, Maoming (G. Liao), the Department of Neurology, Baotou Central Hospital, Baotou (C.J.), the Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing (S.L.), the Department of Neurology, the Affiliated Hospital of Southwest Medical University, Chengdu (J.L.), the Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai (P.Y.), and the Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang (Z.R.) — all in China; the Department of Neurology and Radiology, Boston Medical Center, Boston (T.N.N.); the Department of Neurology, University of California, Los Angeles, Los Angeles (D.S.L.); and the Department of Neurosurgery, Division of Surgery, St. Michael’s Hospital, University of Toronto, Toronto (V.M.P.).

        • Contributors ZM had full access to all data in the study, is responsible for the overall content, and serves as the guarantor of this study. LZ and FC contributed equally to this work. Concept and design: TNN, XH, BJ, ZM. Acquisition, analysis, or interpretation of data: FC, YP, YL, MW, Li, DS. Drafting of the manuscript: LZ. Proofreading and polishing the manuscript: TNN, BJ. Critical review of the manuscript for important intellectual content: All authors.Statistical analysis: YP, YL, MW. Obtained funding: AM. Administrative, technical, or material support: YP, XH, ZM. Supervision: TNN, YP, XH, BJ, ZM.

        • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

        • Competing interests None declared.

        • Provenance and peer review Not commissioned; externally peer reviewed.

        • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.