Abstract 17946: High Baseline CT ASPECTS Correlates With Perfusion-Based Patient Selection for Intra-arterial Recanalization in Acute Ischemic Stroke, but May Be Poor Discriminator of Functional Outcomes
Purpose: To evaluate the baseline CT ASPECTS in acute ischemic stroke (AIS) patients selected for intra-arterial (IA) reperfusion therapy based on perfusion mismatch profiles and its predictive value for clinical outcomes following recanalization.
Methods: A multicenter retrospective study was performed with the following inclusion criteria: baseline NIHSSS >8, presentation <8 hours from symptom onset, CTA/MRA verified M1-M2 MCA/ICA occlusion, and favorable perfusion (CTP/MR DWI-PWI) mismatch profile who underwent IA thrombolysis/thrombectomy. Successful recanalization and good functional outcome were defined as TICI > 2b/3 and mRS score of 0-2, respectively. One neuroradiologist conducted blinded scoring of ASPECTS for all baseline noncontrast CT scans. For evaluation of inter-rater reliability, scores by another neuroradiologist were used and analyzed using Intraclass Correlation Coefficient (ICC). ASPECTS were dichotomized into >7 and ≤7 for primary analysis. Univariate and multivariate statistical analyses were performed. The discriminative capability of ASPECTS in prediction of good functional outcome was evaluated using ROC curve analysis.
Results: Ninety two patients (52 F/40 M; mean age of 71.2±15.5 years) were studied. Successful recanalization (n=50) was highly correlated with good functional outcomes (n=51) (P < 0.001). Interobserver agreement for ASPECTS reading was good (ICC=0.80). Patients with ASPECTS >7 (n=52) and ≤7 (n=40) were comparable in baseline characteristics, medical history, and treatment related variables (successful recanalization and time from symptom onset to recanalization). Relatively high ASPECTS correlated with perfusion-based patient selection with mean and median ASPECTS of eight. No significant correlation was observed between ASPECTS and final clinical outcomes (P=0.6). ASPECTS >7 did not correlate with final outcome in patients with successful recanalization (P=0.5). The discriminative power of the ASPECTS 7 was poor for the prediction of good functional outcome (P=0.7, AUC=0.52).
Conclusion: Favorable baseline CT ASPECTS correlated with favorable perfusion mismatch profiles but did not clearly predict good functional outcomes independent of recanalization.
- © 2013 by American Heart Association, Inc.