Borderline Alberta Stroke Programme Early CT Score Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion May Find Benefit with Endovascular Thrombectomy

Caitriona Logan; Julian Maingard; Kevin Phan; Ronan Motyer; Christen Barras; Seamus Looby; Paul Brennan; Alan O'Hare; Duncan Mark Brooks; Ronil V Chandra; Hamed Asadi; Hong Kuan Kok; John Thornton

doi:10.1016/j.wneu.2017.11.068

Borderline Alberta Stroke Programme Early CT Score Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion May Find Benefit with Endovascular Thrombectomy

World Neurosurg. 2018 Feb:110:e653-e658. doi: 10.1016/j.wneu.2017.11.068. Epub 2017 Nov 22.

Authors

Affiliations

¹ Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland.
² Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Electronic address: [email protected].
³ NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.
⁴ Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia.
⁵ Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia.
⁶ Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; Department of Imaging, Monash University, Melbourne, Australia.
⁷ Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; Department of Imaging, Monash University, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia. Electronic address: [email protected].

PMID: 29175568
DOI: 10.1016/j.wneu.2017.11.068

Abstract

Objective: Selection of patients with acute ischemic stroke for endovascular thrombectomy (EVT) is complex and time-critical. Benefits of EVT are well established for patients with small core infarcts. The aim of this study was to compare clinical outcomes of EVT in patients with larger established infarcts (Alberta Stroke Programme Early CT Score [ASPECTS] ≤6) with patients with smaller infarcts (ASPECTS 7-10).

Methods: The study included 355 patients with acute ischemic stroke due to large vessel occlusion who underwent EVT. ASPECTS was assigned to baseline noncontrast computed tomography, and collateral perfusion scores were assigned to multiphase computed tomography angiography. Baseline stroke severity, collateral grading, and clinical outcome data (complication rate, symptomatic intracranial hemorrhage and 90-day modified Rankin Scale score) were compared between patients with borderline (≤6) and high (7-10) ASPECTS.

Results: There were 34 (10%) patients with borderline ASPECTS. There was no difference in rate of good clinical outcome (37% vs. 46%, P = 0.852), symptomatic intracerebral hemorrhage (9% vs. 9%, P = 0.984), or mortality (20% vs. 22%, P = 0.818) between patients with borderline ASPECTS and high ASPECTS at 90 days. Moreover, there was no significant difference in collateral perfusion grade.

Conclusions: This study identifies similar clinical benefit of EVT in patients with acute large vessel occlusion stroke with borderline ASPECTS and high ASPECTS.

Keywords: ASPECTS; Acute ischemic stroke; Collateral circulation; Endovascular thrombectomy; Interventional neuroradiology.

MeSH terms

Aged
Alberta
Brain Ischemia / diagnostic imaging*
Brain Ischemia / surgery
Endovascular Procedures*
Female
Humans
Male
Prospective Studies
Retrospective Studies
Severity of Illness Index
Stroke / diagnostic imaging*
Stroke / surgery
Thrombectomy*
Tomography, X-Ray Computed*
Treatment Outcome