Low (0-5) Alberta Stroke Program Early Computed Tomography Score on Admission Predictive of Worse Functional Outcome after Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion

Abstract

BACKGROUND AND PURPOSE We examined functional outcomes of mechanical thrombectomy (MT) procedures following anterior circulation large vessel occlusion (ACLVO)-related acute ischemic strokes (AIS). Results were based on admission non-contrast computed tomography (NCCT) studies, using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as standard metric. METHODS Qualifying subjects were consecutive patients (N = 327) at a single center undergoing MT for ACLVO-related AIS. Each was grouped according to ASPECTS status on admission, determined from NCCT images by two physicians. Primary clinical endpoint was functional independence, assessed via modified Rankin Scale (mRS) at 90 days. Secondary endpoints were vessel recanalization (ie, modified Thrombolysis in Cerebral Infarction [mTICI] score), symptomatic intracranial hemorrhage (sICH), and mortality. RESULTS In this study population (mean age, 63.6 ± 12.5 years; women, 29.3%; median baseline National Institute of Health Stroke Scale [NIHSS] score, 15.2 ± 4.5), patients were stratified by ASPECTS tier at presentation, either 0–5 (n = 43) or 6–10 (n = 284). Multivariate logistic regression showed a relation between ASPECTS values ≤ 5 and lesser chance of 90-day functional improvement (OR = 1.40, 95% confidence interval [CI]: 1.00-5.80; p = 0.049), once adjusted for age, baseline NIHSS score, diabetes mellitus, atrial fibrillation/flutter, current/prior alcohol intake, HbA1c concentration, D-dimer level, occlusion of internal carotid artery (ICA), occlusion of ICA and middle cerebral artery (ICA + MCA), numbers of device passes, and successful recanalization. CONCLUSIONS ASPECTS values ≤ 5 correspond with worse long-term functional improvement (mRS scores > 2) in patients undergoing MT for ACLVO-related AIS. Other independent determinants of functional outcomes after MT are age, baseline NIHSS score, HbA1c concentration, and successful recanalization.