Alberta Stroke Program Early CT Score Versus Computed Tomographic Perfusion to Predict Functional Outcome After Successful Reperfusion in Acute Ischemic Stroke

Demeestere, Jelle; Scheldeman, Lauranne; Cornelissen, Sandra; Heye, Sam; Wouters, Anke; Dupont, Patrick; Christensen, Søren; Mlynash, Michael; Albers, Gregory W.; Lansberg, Maarten G.; Lemmens, Robin

doi:10.1161/strokeaha.118.021961

Cited by 59 publications

(54 citation statements)

References 20 publications

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“…Although ASPECTS values were not predictive of functional outcome in our study, they were predictive of final infarction volume concordant with prior reports. 34 Using automated ASPECTS, a recent study by Demeestere et al 34 showed findings similar to ours by demonstrating a lack of association with functional outcome but significant correlation in the determination of final infarction volume. We found 3 variables, including age, NIHSS, and final infarction volume, as significant contributors to predicting functional outcome.…”

Section: Discussionsupporting

confidence: 80%

Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

Sundaram¹,

Goldstein²,

Wheelwright

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Automated ASPECTS has the potential of reducing interobserver variability in the determination of early ischemic changes. We aimed to assess the performance of an automated ASPECTS software against the assessment of a neuroradiologist in a comparative analysis with concurrent CTP-based CBV ASPECTS. MATERIALS AND METHODS: Patients with anterior circulation stroke who had baseline NCCT and CTP and underwent successful mechanical thrombectomy were included. NCCT-ASPECTS was assessed by 2 neuroradiologists, and discrepancies were resolved by consensus. CTP-CBV ASPECTS was assessed by a different neuroradiologist. Automated ASPECTS was provided by Brainomix software. ASPECTS was dichotomized (ASPECTS $6 or ,6) and was also based on the time from onset (.6 or #6 hours). RESULTS: A total of 58 patients were included. The interobserver agreement for NCCT ASPECTS was moderate (k = 0.48) and marginally improved (k = 0.64) for dichotomized data. Automated ASPECTS showed excellent agreement with consensus reads (k = 0.84) and CTP-CBV ASPECTS (k = 0.84). Intraclass correlation coefficients for ASPECTS across all 3 groups were 0.84 (95% CI, 0.76-0.90, raw scores) and 0.94 (95% CI, 0.91-0.96, dichotomized scores). Automated scores were comparable with consensus reads and CTP-CBV ASPECTS in patients when grouped on the basis of time from symptom onset (.6 or #6 hours). There was significant (P , .001) negative correlation with final infarction volume and the 3 ASPECTS groups (r = À0.52, consensus reads; À0.58, CTP-CBV; and À0.66, automated). CONCLUSIONS: ASPECTS derived from an automated software performs equally as well as consensus reads of expert neuroradiologists and concurrent CTP-CBV ASPECTS and can be used to standardize ASPECTS reporting and minimize interpretation variability.

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Section: Discussionsupporting

confidence: 80%

Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

Sundaram¹,

Goldstein²,

Wheelwright

et al. 2019

AJNR Am J Neuroradiol

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“…In addition, compared with preoperative multimodel imaging(CT or Magnetic resonance),LSAs has advantages of shorter time and easier operation, and provides potentially new decision-making factors for emergency thrombectomy in hospitals without preoperative evaluation of core infarction and ischemic penumbra. This study also confirmed the core infarct volume is an independent prognostic predictors for thrombectomy,which is similar to other studies [22][23][24] .…”

Section: Discussionsupporting

confidence: 92%

Lenticulostriate arteries appearance before thrombectomy predicts good outcome in acute middle cerebral artery occlusion

Liu

Chen

Hong

et al. 2019

Preprint

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Purpose Endovascular therapy is widely used in acute large vessel occlusion. This study investigated whether imaging of lateral lenticulostriate arteries(LSAs) before thrombectomy would potentially be helpful for predicting prognosis of patients with acute M1 segment of middle cerebral artery occlusion(MCAO).Methods 59 consecutive patients with acute M1 segment of MCAO treated with mechanical thrombectomy at two comprehensive stroke center were analyzed. Patients were categorized into LSA+ (appearing of lateral LSAs) and LSA- (sparing of lateral LSAs) group according to preprocedural digital substraction angiography (DSA).Baseline data and clinical outcomes were compared. A good clinical outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and imaging parameters and functional outcome was evaluated with logistic regression analysis.Results LSA+ was shown in 36 patients (61%). LSA+ group had a significantly higher proportion of good outcome (72.2% vs. 8.7%, OR 27.3,95% CI 5.38-138.4, P <0.001), lower risk of symptomatic intracranial haemorrhages (sICH) (8.3% vs. 47.8%,OR 0.10,95% CI 0.02-0.42, P =0.001) and lower mortality in hospital (5.6% vs. 34.8%, OR 0.11,95% CI 0.02 -0.58, P <0.004) compared with LSA- group. Patients in LSA+ group had lower baseline NIHSS score( P <0.01) and NIHSS score at 14 days( P <0.01) and smaller infarct core volume( P =0.016) on computed tomography perfusion imaging (CTP) compared to the LSA- group. Multivariate logistic regression analysis showed that a small infarct core volume (OR 6.74,95% CI 1.148-39.569, P =0.035) and LSA+(OR 22.114,95% CI 3.339-146.470, P =0.001) were associated with a good clinical outcome.Conclusions Our data suggest that appearance of lateral LSAs before mechanical thrombectomy would be potentially helpful for predicting favorable prognosis of patients with acute M1 segment of MCAO.

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“…The assessment of LSAs on pre-interventional DSA provides potentially new decision-making factors for emergency thrombectomy in hospitals without preoperative evaluation of core infarct and ischemic penumbra. This study also confirmed the core infarct volume was an independently prognostic predictors for thrombectomy, which is similar to other studies [28][29][30].…”

Section: Discussionsupporting

confidence: 92%

Lenticulostriate arteries appearance before thrombectomy predicts good outcome in acute middle cerebral artery occlusion

et al. 2020

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Background: Endovascular therapy is widely used in acute large vessel occlusion. This study investigated whether imaging of lateral lenticulostriate arteries (LSAs) before thrombectomy would potentially be helpful for predicting prognosis of patients with acute M1 segment of middle cerebral artery occlusion (MCAO). Methods: 59 consecutive patients with acute M1 segment of MCAO treated with mechanical thrombectomy at two comprehensive stroke centers were analyzed. Patients were categorized into LSA+ (appearing of lateral LSAs) and LSA-(sparing of lateral LSAs) group according to preprocedural digital substraction angiography (DSA). Baseline data and clinical outcomes were compared. A good clinical outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and imaging parameters and functional outcome was evaluated with logistic regression analysis. Results: LSA+ was shown in 36 patients (61%). LSA+ group had a significantly higher proportion of good outcome (72.2% vs. 8.7%, OR 27.3,95% CI 5.38-138.4, P < 0.001), lower risk of symptomatic intracranial haemorrhages (sICH) (8.3% vs. 47.8%,OR 0.10,95% CI 0.02-0.42, P = 0.001) and lower mortality in hospital (5.6% vs. 34.8%, OR 0.11,95% CI 0.02-0.58, P < 0.004) compared with LSA-group. Patients in LSA+ group had lower baseline NIHSS score(P < 0.01) and NIHSS score at 14 days(P < 0.01) and smaller infarct core volume (P = 0.016) on computed tomography perfusion imaging (CTP) compared to the LSA-group. Multivariate logistic regression analysis showed that a small infarct core volume (OR 6.74,95% CI 1.148-39.569, P = 0.035) and LSA+(OR 22.114,95% CI 3.339-146.470, P = 0.001) were associated with a good clinical outcome. Conclusions: Our data suggest that appearance of lateral LSAs before mechanical thrombectomy would be potentially helpful for predicting favorable prognosis of patients with acute M1 segment of MCAO.

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Alberta Stroke Program Early CT Score Versus Computed Tomographic Perfusion to Predict Functional Outcome After Successful Reperfusion in Acute Ischemic Stroke

Cited by 59 publications

References 20 publications

Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

Lenticulostriate arteries appearance before thrombectomy predicts good outcome in acute middle cerebral artery occlusion

Lenticulostriate arteries appearance before thrombectomy predicts good outcome in acute middle cerebral artery occlusion

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