Alejandro M Spiotta1, Jan Vargas1, Harris Hawk2, Raymond Turner1, M Imran Chaudry2, Holly Battenhouse3, Aquilla S Turk2. 1. Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA. 2. Department of Radiology, Neurointerventional, Medical University of South Carolina, Charleston, South Carolina, USA. 3. Data Coordination Unit, Department of Public Health Services, Medical University of South Carolina, Charleston, South Carolina, USA.
Abstract
INTRODUCTION: This study investigates whether the Alberta Stroke Program Early CT Score (ASPECTS) quantification is associated with outcome following mechanical thrombectomy. OBJECTIVE: To determine whether preintervention non-perfect ASPECT scores involving cortical or subcortical regions and the side of the non-perfect ASPECT score affects outcomes. METHODS: A retrospective review of a prospectively maintained database of patients with acute ischemic stroke involving the anterior circulation who underwent thrombectomy between May 2008 and August 2012 at a single tertiary care center. The device for mechanical thrombectomy used was the penumbra aspiration system (Penumbra Inc, Alameda, California, USA) and the Solitaire stent retriever (ev3, Irvine, California, USA). A 'blinded' neuroradiologist obtained ASPECTS quantification and noted each region demonstrating early changes. RESULTS: 149 patients (51.7% female, mean age 66.1±15.1 years) were included with an average National Institutes of Health Stroke Scale of 16.2±6.7. Patients with non-perfect ASPECT scores on pretreatment imaging were more likely to have a hemorrhagic conversion (p=0.04) evident on post-procedure CT. However, functional outcomes were the same. Patients with both cortical and basal ganglia non-perfect ASPECT scores were more likely to be in a persistent vegetative state or expire. No differences were identified in outcome among patients with left- versus right-sided infarcts affecting the basal ganglia or cortical regions. CONCLUSIONS: These findings support a strategy of selecting candidacy for thrombectomy that does not exclude patients with non-perfect ASPECT scores involving either the basal ganglia or cortical regions. Outcomes were identical among patients with no non-perfect ASPECT scores and those with cortical or subcortical infarcts, despite a higher incidence of hemorrhagic conversion found among those with non-perfect ASPECT scores. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
INTRODUCTION: This study investigates whether the Alberta Stroke Program Early CT Score (ASPECTS) quantification is associated with outcome following mechanical thrombectomy. OBJECTIVE: To determine whether preintervention non-perfect ASPECT scores involving cortical or subcortical regions and the side of the non-perfect ASPECT score affects outcomes. METHODS: A retrospective review of a prospectively maintained database of patients with acute ischemic stroke involving the anterior circulation who underwent thrombectomy between May 2008 and August 2012 at a single tertiary care center. The device for mechanical thrombectomy used was the penumbra aspiration system (Penumbra Inc, Alameda, California, USA) and the Solitaire stent retriever (ev3, Irvine, California, USA). A 'blinded' neuroradiologist obtained ASPECTS quantification and noted each region demonstrating early changes. RESULTS: 149 patients (51.7% female, mean age 66.1±15.1 years) were included with an average National Institutes of Health Stroke Scale of 16.2±6.7. Patients with non-perfect ASPECT scores on pretreatment imaging were more likely to have a hemorrhagic conversion (p=0.04) evident on post-procedure CT. However, functional outcomes were the same. Patients with both cortical and basal ganglia non-perfect ASPECT scores were more likely to be in a persistent vegetative state or expire. No differences were identified in outcome among patients with left- versus right-sided infarcts affecting the basal ganglia or cortical regions. CONCLUSIONS: These findings support a strategy of selecting candidacy for thrombectomy that does not exclude patients with non-perfect ASPECT scores involving either the basal ganglia or cortical regions. Outcomes were identical among patients with no non-perfect ASPECT scores and those with cortical or subcortical infarcts, despite a higher incidence of hemorrhagic conversion found among those with non-perfect ASPECT scores. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Authors: Eyad Almallouhi; Sami Al Kasab; Zachary Hubbard; Eric C Bass; Guilherme Porto; Ali Alawieh; Reda Chalhoub; Pascal M Jabbour; Robert M Starke; Stacey Q Wolfe; Adam S Arthur; Edgar Samaniego; Ilko Maier; Brian M Howard; Ansaar Rai; Min S Park; Justin Mascitelli; Marios Psychogios; Reade De Leacy; Travis Dumont; Michael R Levitt; Adam Polifka; Joshua Osbun; Roberto Crosa; Joon-Tae Kim; Walter Casagrande; Shinichi Yoshimura; Charles Matouk; Peter T Kan; Richard W Williamson; Benjamin Gory; Maxim Mokin; Isabel Fragata; Osama Zaidat; Albert J Yoo; Alejandro M Spiotta Journal: JAMA Netw Open Date: 2021-12-01