Abstract 180: Time and Tissue: Imaging of Early Ischemia in FAST-MAG
Background: The NINDS FAST-MAG prehospital stroke trial treated patients in the field, providing unique perspective on the timecourse and tissue effects of ischemia. We characterized the presence of early ischemic changes (EIC) on initial imaging and the relationship with time in FAST-MAG.
Methods: All subjects enrolled in FAST-MAG with a final diagnosis of TIA or stroke were included in our imaging analyses. Clinical and imaging variables in the final dataset were analyzed to establish the extent of EIC and the relationship of ASPECTS total and regional scores with respect to time.
Results: Among 1245 cases of cerebral ischemia (mean age 69 (SD 13), median NIHSS 7 (IQR 2-15), 45% women), first brain imaging was obtained a median of 93 minutes (74-121) after last known well, 28 minutes (19-41.5) after arrival in the ED. EIC included loss of grey-white (27.1%), insular ribbon sign (19.6%), lentiform hypodensity (16.8%) and sulcal effacement (16.0%). ASPECTS score (mean 8.58 (SD 2.4), median 10 (IQR 8-10)) was calculated in 1240. Total ASPECTS exhibited a wide range (1-10), with regional involvement of caudate (2.3%), lentiform (14.7%), insula (23.1%), internal capsule (1.4%), M1 (21.4%), M2 (21.5%), M3 (14.1%), M4 (17.3%), M5 (16.2%) and M6 (9.8%). ASPECTS score was unrelated to time from symptom onset (r=0.008, p=0.77) across this relatively narrow early time period.
Conclusions: Even in the earliest epochs after stroke symptom onset, a wide range of ischemic changes may be evident at imaging. Specific patterns of ischemia or regional predilection may be noted, but the timecourse of tissue changes may vary with each stroke patient.
Author Disclosures: D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. N. Sanossian: None. S. Starkman: None. P. Villablanca: None. A.M. Burgos: None. F. Scalzo: None. M.S. Johnson: None. M. Eckstein: None. S. Stratton: None. F. Pratt: None. R. Conwit: None. S. Hamilton: None. J.L. Saver: None.
- © 2015 by American Heart Association, Inc.