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01-05-2016 | Diagnostic Neuroradiology

Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

Authors: Michal M. Kawiorski, Patricia Martínez-Sánchez, Andrés García-Pastor, Patricia Calleja, Blanca Fuentes, Borja E. Sanz-Cuesta, Daniel Lourido, Begoña Marín, Fernando Díaz-Otero, Agustina Vicente, Fernando Sierra-Hidalgo, Gerardo Ruiz-Ares, Exuperio Díez-Tejedor, Eduardo Fandiño, María Alonso de Leciñana

Published in: Neuroradiology | Issue 5/2016

Abstract

Introduction

Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization.

Methods

Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability).

Results

Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3–0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5–1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %).

Conclusions

CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies.

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Title: Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke
Authors: Michal M. Kawiorski
Patricia Martínez-Sánchez
Andrés García-Pastor
Patricia Calleja
Blanca Fuentes
Borja E. Sanz-Cuesta
Daniel Lourido
Begoña Marín
Fernando Díaz-Otero
Agustina Vicente
Fernando Sierra-Hidalgo
Gerardo Ruiz-Ares
Exuperio Díez-Tejedor
Eduardo Fandiño
María Alonso de Leciñana
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 5/2016
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-016-1652-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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