Value of Brain Computed Tomographic Angiography to Predict Post Thrombectomy Final Infarct Size and Clinical Outcome in Acute Ischemic Stroke

Mungkorn Apirakkan; Withawat Vuthiwong; Chai Kobkitsuksakul; Jesada Keandoungchun; Ekachat Chanthanaphak

doi:10.4103/ajns.AJNS_242_19

Value of Brain Computed Tomographic Angiography to Predict Post Thrombectomy Final Infarct Size and Clinical Outcome in Acute Ischemic Stroke

Asian J Neurosurg. 2019 Nov 25;14(4):1126-1133. doi: 10.4103/ajns.AJNS_242_19. eCollection 2019 Oct-Dec.

Authors

Mungkorn Apirakkan¹, Withawat Vuthiwong¹, Chai Kobkitsuksakul¹, Jesada Keandoungchun², Ekachat Chanthanaphak¹

Affiliations

¹ Division of Interventional Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
² Division of Neurology, Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Abstract

Aims: This study aims to analyze the predictor in preoperative brain computed tomographic angiography (CTA) for final infarct and outcome in postendovascular thrombectomy patient.

Subjects and methods: 52 patients were retrospectively reviewed. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) comparison between preoperative noncontrast computed tomography (NCCT) and 24-h NCCT as well as preoperative CTA source image (CTA-SI) and 24-h NCCT were performed. Factors associated with increased ASPECTS and clinical outcome were evaluated.

Results: Preoperative NCCT ASPECTS = 24-h NCCT in 23%. Whereas, 46% showed preoperative CTA-SI ASPECTS = 24-h NCCT. Moreover, 40.4% showed 24-h NCCT ASPECTS > preoperative CTA-SI (increased ASPECTS). The two significant factors associated with increased ASPECTS are thrombolysis in cerebral infarct score 2b/3 (P = 0.02) and good collateral status (P = 0.02). Finally, good clinical outcome was associated with age <60 (P = 0.04), preoperative CTA-SI ASPECTS >5 (P = 0.01), good collaterals status (P = 0.02), and increased ASPECTS (P = 0.05).

Conclusions: Preoperative brain CTA provided the necessary factors that are associated with good clinical outcomes, which are CTA-SI ASPECTS > 5, good collateral status, and increased ASPECTS.

Keywords: Computed tomographic angiography source image Alberta Stroke Program Early Computed Tomography Score; final infarct volume; increase Alberta Stroke Program Early Computed Tomography Score; stroke outcome.