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O-006 using sequential and post-procedure aspects as predictors of good clinical outcome after intra-arterial therapy for acute ischemic stroke
  1. A Yoo1,
  2. O Zaidat2,
  3. Z Chaudhry3,
  4. O Berkhemer1,
  5. R González1,
  6. M Goyal4,
  7. A Demchuk4,
  8. B Menon4,
  9. E Mualem5,
  10. H Buell5,
  11. S Kuo5,
  12. S Sit5,
  13. A Bose5
  1. 1Texas Stroke Institute, Plano, TX, USA
  2. 2Medical College of Wisconsin, Milwaukee, WI, USA
  3. 3Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  4. 4University of Calgary, Calgary, AB, Canada, USA
  5. 5Penumbra, Inc., Alameda, CA, USA

Abstract

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.

Abstract O-006 Table 1

Correlation between baseline and procedural variables and ordinal mRS (0–6) at 90 days

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..

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