Purpose Final ASPECTS score is a good predictor of patient outcomes after intra-arterial therapy for acute ischemic stroke. The purpose of this study was to compare sequential pre- and post-treatment ASPECTS imaging in predicting outcome.
Methods The PICS Study was a registry of clinical and imaging data from patients with proximal artery occlusion treated by the Penumbra System. A central core laboratory, blinded except for knowledge of the stroke side, determined the ASPECTS scores. The univariate relationship between 90 day mRS (0–6) and age, baseline NIHSS, discharge to 7 day NIHSS, as well as pre- and post-treatment ASPECTS (0–10) and ASPECTS change was evaluated with the Spearman’s correlation coefficient. Variables with significance of p < 0.20 were included as covariates in the multiple logistic regression models for good outcome defined as 90 day mRS 0–2. The level of significance was set at p < 0.05.
Results Within the study, 142 patients met inclusion criteria for this analysis, with a mean age of 67.8 ± 15.5 and median admission NIHSS score of 16.0 (IQR 12.0–21.0). Logistic regression analysis was utilized to evaluate the impact of covariates on 90-day good outcome (mRS 0–2). After adjusting for age and baseline NIHSS, post-treatment ASPECTS showed a stronger relationship with good outcome (Large Odds Ratio 0.20; p = 0.0063) than pre-treatment ASPECTS (Large Odds Ratio 0.33; p = 0.24). Post-treatment worsening in ASPECTS was also a significant predictor of 90 day mRS (Odds Ratio 0.75 per 1 point worsening; p = 0.047) in the multivariate analysis.
Conclusion Overall, sequential and post-procedure ASPECTS were better indicators of clinical outcome following intra-arterial therapy than pre-ASPECTS. Final infarct volume measured using ASPECTS could aid as a surrogate biomarker for long-term functional outcome, and ASPECTS decline may serve as a biomarker for procedural effectiveness.
Disclosures A. Yoo: 1; C; NIH, Penumbra, Inc., Remedy Pharmaceuticals. O. Zaidat: 1; C; Penumbra, Inc.. 2; C; Stryker, Gore Medical. 4; C; Galaxy Therapeutics. Z. Chaudhry: None. O. Berkhemer: None. R. González: None. M. Goyal: None. A. Demchuk: None. B. Menon: None. E. Mualem: 5; C; Penumbra, Inc. H. Buell: 5; C; Penumbra, Inc. S. Kuo: 5; C; Penumbra, Inc. S. Sit: 4; C; Penumbra, Inc.. 5; C; Penumbra, Inc. A. Bose: 4; C; Penumbra, Inc.. 5; C; Penumbra, Inc..