Faculty Collaboration Database

Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy. Stroke 2014 Mar;45(3):746-51

Date

02/08/2014

Pubmed ID

24503670

DOI

10.1161/STROKEAHA.113.004260

Scopus ID

2-s2.0-84899152374 (requires institutional sign-in at Scopus site)   80 Citations

Abstract

BACKGROUND AND PURPOSE: The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT.

METHODS: The study cohort was derived from multicenter trials of the Penumbra System. Inclusion criteria were anterior circulation proximal occlusion, evaluable pretreatment NCCT, and known time to reperfusion. Ischemic change was quantified using the Alberta Stroke Program Early CT Score (ASPECTS) and stratified into 3 prespecified groups for comparison: 0 to 4 (most ischemic change) versus 5 to 7 versus 8 to 10 (least ischemic change).

RESULTS: A total of 249 patients were analyzed: 40 with ASPECTS 0 to 4, 83 with ASPECTS 5 to 7, and 126 with ASPECTS 8 to 10. For ASPECTS 0 to 4, 5 to 7, and 8 to 10, respectively, good outcome (modified Rankin Scale score, 0-2) rates were 5%, 38.6%, and 46% (P<0.0001), and mortality rates were 55%, 28.9%, and 19% (P=0.0001). The only significant pairwise differences were between ASPECTS 0 to 4 and other groups. Symptomatic hemorrhage was more common with lower ASPECTS (P=0.02). Shorter time to reperfusion was significantly associated with better outcomes among patients with ASPECTS 8 to 10 (P=0.01). A similar relationship was seen for ASPECTS 5 to 7 but was not statistically significant. No such relationship was seen for ASPECTS 0 to 4.

CONCLUSIONS: NCCT seems useful for excluding patients with the greatest burden of ischemic damage from futile intra-arterial treatment, which is unlikely to result in patient functional independence and increases the risk of hemorrhage.

Author List

Yoo AJ, Zaidat OO, Chaudhry ZA, Berkhemer OA, González RG, Goyal M, Demchuk AM, Menon BK, Mualem E, Ueda D, Buell H, Sit SP, Bose A, Penumbra Pivotal and Penumbra Imaging Collaborative Study (PICS) Investigators

MESH terms used to index this publication - Major topics in bold

Aged
Alberta
Brain Ischemia
Cerebral Angiography
Cerebral Hemorrhage
Cohort Studies
Data Interpretation, Statistical
Female
Functional Laterality
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Reperfusion
Stroke
Thrombolytic Therapy
Tomography, X-Ray Computed
Treatment Outcome