Abstract TP57: Post-Procedure ASPECTS Score Incorporating Parenchymal Hyperdensity Correlates with Clinical Outcome After Endovascular Therapy
Introduction: Noncontrast head CT (NCHCT) is routinely acquired after endovascular therapy for acute stroke to evaluate for early complications, yet residual contrast staining is common. We hypothesized that modification of ASPECTS scoring to include any region involved with either abnormal hypodensity or hyperdensity may accurately correlate with subsequent clinical outcomes.
Methods: Consecutive patients with M1 or M2 MCA occlusion treated over a 2-year period were analyzed. All patients that underwent immediate post-procedure CT and MRI within 24 hours were included. Clinical and radiological data was reviewed. A modified ASPECTS scoring system was applied that considered areas of parenchymal hyperdensity as also being involved by ischemic injury.
Results: A total of 30 patients were identified, including 14 men and 16 women with an average age of 64.5 years old. Endovascular recanalization procedures were performed with either the MERCI and\or Penumbra devices. Comparison of the modified ASPECTS score on the post-procedure CT with the post procedure ASPECTS score on DWI MRI demonstrated good correlation with no statistically significant difference (p = .260). On the immediate post-procedure CT, patients with a modified ASPECTS score greater than or equal to 7 versus those with a score less than 7 had an average NIHSS reduction at discharge of 7.3 versus 2.2 (p=.014) and 90 day modified Rankin score of 2.3 versus 4.5 (p=.002). Presence of parenchymal hyperdensity versus no hyperdensity on the post-procedure CT alone did not correlate with clinical outcomes using NIHSS or 90 day modified Rankin score (p=.120 and p=.069 respectively).
Conclusions: Evaluation of the immediate post procedure NCHCT using a modified ASPECTS scoring system, which incorporates any parenchymal hyperdensity, may be useful to judge clinical response to the intervention. Patients with modified ASPECT score greater than or equal to 7 did significantly better than those with lower scores. Presence of parenchymal hyperdensity alone did not correlate with clinical outcomes.
- © 2012 by American Heart Association, Inc.