Post-stroke ASPECTS predicts outcome after thrombectomy
- PDF / 256,535 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 87 Downloads / 208 Views
INTERVENTIONAL NEURORADIOLOGY
Post-stroke ASPECTS predicts outcome after thrombectomy Ronen R. Leker 1
&
Asaf Honig 1 & Andrei Filioglo 1 & Naaem Simaan 1 & John M. Gomori 2 & Jose E. Cohen 3
Received: 30 June 2020 / Accepted: 29 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Infarct growth and final infarct volume are established outcome modifiers following endovascular thrombectomy (EVT) for patients with large vessel occlusion stroke (LVO). Simple techniques for final infarct volume measurement are lacking, and therefore, we tested whether post-EVT ASPECTS can be used for prognostic evaluation after EVT. Methods Infarct size at baseline was measured in a prospective cohort of patients with LVO that underwent EVT with the ASPECTS score on admission non-contrast CT. Final infarct size was assessed with a post-EVT ASPECTS (ASPECTS-POST) obtained from a follow-up CT 24–72 h post-EVT. The best performing ASPECTS-POST was chosen based on comparisons of different thresholds. Outcome measures included survival rates and modified Rankin Score at 90 days. Results A total of 272 patients were included and 166 of them had an ASPECTS-POST ≥ 7. ASPECTS-POST ≥ 7 was associated with increased likelihood of favorable outcome at 90 days (67% vs. 21%, p < 0.001) with sensitivity, specificity, and positive and negative predictive values of 86%, 58%, 61%, and 85%, respectively. On multivariate analysis, ASPECTS-POST ≥ 7 was found to be a significant modifier of favorable outcome (Odds Ratio [OR] 6.2, 95% confidence intervals [CI] 3.1–12.4) and survival (OR 5.8 95% CI 2.4–14.3). Conclusion ASPECTS can be rapidly and easily obtained from the post-EVT NCCT and ASPECTS-POST ≥ 7 correlates with good outcome. Keywords Cerebrovascular disease . Endovascular . Stroke . Thrombectomy . ASPECTS
Introduction Large vessel occlusion (LVO) in the anterior circulation causes large hemispheric infarctions that are amenable to treatment with endovascular thrombectomy (EVT) [1]. Early infarct growth [2–4] and final infarct volume [2, 5–9] have been associated with outcome in these patients. However, methods for evaluation of these parameters usually involved employing sophisticated software that is both time and resource consuming [2, 5–12]. A simpler, less expensive method of assessing infarct volumes may be advantageous under
these circumstances. The Alberta Stroke Project Early CT Changes Score (ASPECTS) is a well-established simple-touse tool for assessing infarct volumes on the pre-EVT noncontrast CT scans (NCCT) [13–18]. As such, it can be used for patient selection for EVT and is associated with outcome after EVT [13–18]. We therefore reasoned that assessment of ASPECTS on the post-EVT NCCT (ASPECTS-POST) can be used to prognosticate and may assist in making therapeutic decisions after EVT including rehabilitation status, nursing care placement, and withdrawal of care. Therefore, we aimed to identify cutoffs optimally correlated with outcome and examine the predictive value of these ASPECTS-P
Data Loading...
