Abstract TP36: Collaterals Negate Time: Topography and Determinants of Baseline ASPECTS in STRATIS
Background: ASPECTS is routinely used to estimate ischemic lesion burden in acute stroke, yet the topography and influence of collaterals has been unexplored. Imaging selection for endovascular therapy in various time epochs may also be simplified with ASPECTS. We leveraged the large-scale registry data of STRATIS to discern the role of collaterals, time and other factors in ASPECTS topography at baseline.
Methods: The STRATIS Imaging Core Lab, blind to all clinical data, independently determined ASPECTS scores and regional involvement in anterior circulation occlusions. Collateral status on baseline angiography was scored by ASITN grade. Statistical analyses described ASPECTS regional involvement or topography based on arterial occlusion site and other variables available prior to intervention, determining the influence of collaterals and time duration from onset to imaging.
Results: Baseline ASPECTS (n=573) was median 8.0 (2, 10). ASPECTS regions involved were lenticular nuclei 62.3% (357/573), insula 42.2% (242/573), caudate 23.4% (134/573), M2 13.6% (78/573), M4 9.4% (54/573), M5 9.2% (53/573), M1 4.0% (23/573), M3 2.1% (12/573), M6 1.9% (11/573) and internal capsule 0.2% (1/573). Distinct patterns or topography differentiated ICA, M1 and M2 arterial occlusion sites at angiography. Overall, higher ASPECTS (7-10 vs. ≤ 6) was linked with more robust collaterals (p<0.001) and shorter duration from onset to CT (p=0.001), yet collateral grade was unrelated to time. Ordinal multivariate logistic regression on ASPECTS containing collateral grade and time (from onset to CT) as covariates demonstrated that they were significantly associated (p<0.001 and p=0.0024, respectively) with ASPECTS.
Conclusions: ASPECTS topography and the extent of ischemic changes are a product of arterial occlusion site, collateral status and time duration. ASPECTS may infer collateral status, a pivotal determinant of outcome in endovascular therapy, irrespective of time from symptom onset.
Author Disclosures: D.S. Liebeskind: Consultant/Advisory Board; Significant; Medtronic, Stryker. G.W. Woolf: None. N. Mueller-Kronast: Consultant/Advisory Board; Modest; modest. Consultant/Advisory Board; Significant; Medtronic Neurovascular Consultant. M.A. Aziz-Sultan: Other; Modest; Covidien. M.T. Froehler: Employment; Significant; Vanderbilt. Research Grant; Significant; NIH. Consultant/Advisory Board; Modest; Medtronic, Blockade. R.P. Klucznik: Speakers’ Bureau; Modest; Medtronic Neurovascular. J.L. Saver: Other; Modest; Other; Modest; Dr. Saver is an employee of the University of California. The University of California, Regents receive funding for Dr Saver’s services as a scientific, consultant regarding trial design. The University of California, Regents receive funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to, Covidien, Stryker, BrainsGate, Pfizer & St. Jude Medical, Dr. Saver has served as an unpaid site investigator in multicenter trials run by Lundbeck for which UC Regents received, payments on basis of clinical trial contracts for the number of subjects enrolled, Dr. Saver serves as an unpaid consultant to Genentech advising on design & conduct of PRISMS trial;, neither Univ. of California nor Dr. Saver received any payments for this voluntary unpaid service. The University of California has patent rights in retrieval devices for stroke. N. Sanossian: Speakers’ Bureau; Modest; Genentech. Consultant/Advisory Board; Modest; Medtronic. O.O. Zaidat: None. D.C. Haussen: None. F.R. Hellinger: None. D.R. Yavagal: Honoraria; Modest; Guidepoint. Consultant/Advisory Board; Modest; Medtronic, Neuralanalytics, Inc. Other; Modest; ESCAPE trial DSCMB member. T.L. Yao: Consultant/Advisory Board; Modest; Medtronic. R. Jahan: Consultant/Advisory Board; Significant; Medtronic.
- © 2017 by American Heart Association, Inc.