Abstract W P41: Multimodal Imaging ASPECTS: A Predictor Of Good Prognosis Before Thrombectomy
BACKGROUND: The goal of this study was to determine the accuracy and reliability of noncontrast CT (NCCT), perfusion CT parameters maps (CTP) an CT-angiography source images (CTASI), analyzed with ASPECTS (Alberta Stroke Program Early CT Scale), as final outcome predictors of endovascular stroke treatment.
METHODS: Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed (04/2009-06/2014). In acute stroke patients NCCT, CTP-CBV (maps of Cerebral Blood Volume) and CTASI was performed according to our hospital guidelines before thrombectomy. We independently applied the ASPECTS in all baselines NCCT, CBV-CTP, CTASI and follow-up NCCT 24H. Receiver-operating characteristic curve (ROC) analysis was performed to determine optimal thresholds for imaging parameters to predict dichotomized good clinical outcome (modified Rankin score ≤2, mRS).
RESULTS: From a database containing 402 thrombectomies, 94 underwent CTP and CTA for acute cerebrovascular ischemia. Ninety-one with MCA or ICA occlusion were identified for our study (49% women, mean age 64+/-13 years; NIHSS at admission 17). Successful recanalization (TICI 2b-3) was achieved in 73/91 patients (80%).
In ROC analysis higher CBV ASPECTS was associated with 90-day mRS score 0-2 (Area Under Curve=0.72;95% CI, 0.6-0.8; P:0.001) with optimal threshold of 8 (Sensivity 83%, Specificity 77%).
The CTASI ASPECTS was highly correlated with 24h NCCT ASPECTS (r: 0.65;Spearman p:0.001). Favorable clinical outcomes (mRS 0-2) was greater in patients with CBV ASPECTS >8 compared with ≤8 (71% vs 37%;p:0.001) and CTACI ASPECTS>8 compared with ≤8 (68% vs 37%;p=0.02).
In multivariate logistic regression CBV ASPECTS was associated with significant functional and radiological outcomes after adjustment for age, sex, time from CT to groin-puncture and baseline NIHSS (OR: 2.5; 95%CI:1.8-3.5, p:0.001).
CONCLUSIONS: These results suggest that CBV ASPECTS approach can predict a favorable clinical outcome after endovascular treatment with good sensitivity and specificity.
CTASI ASPECTS may be more sensitive for detection of infarction and more accurate for predicting the final infarct size however not to predict clinical outcome.
Author Disclosures: P. Cardona: None. H. Quesada: None. L. Cano: None. B. Lara: None. F. Rubio: None. L. Aja: None. R. Barranco: None. M. De Miquel: None. A. Escrig: None.
- © 2015 by American Heart Association, Inc.