Predictive Value of the Alberta Stroke Program Early CT Score (ASPECTS) in the Outcome of the Acute Ischemic Stroke and Its Correlation with Stroke Subtypes, NIHSS, and Cognitive Impairment

Abstract

Objectives. This study is aimed at correlating ASPECTS with mortality and morbidity in patients with acute middle cerebral artery territory infarction and at determining the cutoff value of ASPECTS that may predict the outcome. Methods. 150 patients diagnosed with acute middle cerebral artery territory infarction were involved in this study. Risk factors, initial NIHSS, and GCS were determined. An initial or follow-up noncontrast CT brain was done and assessed by ASPECTS. Outcomes were determined by mRS during the follow-up of cases after 3 months. Correlations of ASPECTS and outcome variables were done by Spearman correlation. Logistic regression analysis and ROC curve were done to detect the cutoff value of ASPECTS that predicts unfavorable outcomes. Results. The most common subtypes of ischemic strokes were lacunar stroke in 66 patients (44%), cardioembolic stroke in 39 patients (26%), and LAA stroke in 30 cases (20%). The cardioembolic stroke had a statistically significant lower ASPECT score than other types of ischemic strokes ( P < 0.05 ). Spearman correlation showed that lower ASPECTS values (worse outcome) were more in older patients and associated with lower initial GCS. ASPECTS values were inversely correlated with initial NIHSS, inpatient stay, inpatient complications, mortality, and mRS. The ASPECTS cutoff value determined for the prediction of unfavorable outcomes was equal to ≤7. The binary logistic regression analysis detected that patients with ASPECTS ≤ 7 were significantly associated with about fourfold increased risk of poor outcomes (OR 3.95, 95% CI 2.09–11.38, and P < 0.01 ). Conclusions. ASPECTS is a valuable and appropriate technique for the evaluation of the prognosis in acute ischemic stroke. Patients with high ASPECTS values are more likely to attain favorable outcomes, and the cutoff value of ASPECTS is a strong predictor for unfavorable outcomes. This trial is registered with ClinicalTrials.gov NCT04235920.

Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis

“…The 6 studies, comprising 735 patients, included in the meta-analysis demonstrated that there was a significant association of increasing ASPECTS with poor functional outcomes at 90 days (SMD = −1.15; 95% CI −1.77–−0.52; p < 0.0001) ( Figure 3 ) [ 16 , 19 , 22 , 33 , 35 , 38 ]. Moderate to considerable heterogeneity was found between the studies (I 2 = 93.1%, p < 0.0001).…”

Introductory Chapter: Neurological Disorders - Therapy Approaches

“…Stroke [39,40] There are 3 types of strokes: ischemic stroke (when blood flow through the artery to the brain becomes blocked, such as blood clots); hemorrhagic stroke (when an artery in the brain breaks and puts too much pressure on brain cells damaging them, that can be intracerebral hemorrhage or subarachnoid hemorrhage); and transient ischemic attack (when blood flow to the brain is blocked for only a short time-usually no more than 5 minutes). The ischemic stroke corresponds to 87% of strokes.…”

Whole-Body Vibration Approaches in Neurological Disorders

“…There are three types of strokes: i) ischemic stroke, referring to a block of blood flow through the artery to the brain, such as blood clots; ii) hemorrhagic stroke, characterizing a damage of the artery in the brain and pressure on brain cells, favoring the intracerebral hemorrhage or the subarachnoid hemorrhage; and iii) transient ischemic attack, that occurs when blood flow to the brain is blocked for only a short time (usually no more than 5 minutes) [31].…”