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  • Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization

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Ischemic Stroke
Original research
Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization
  1. Gabriel Broocks1,
  2. Helge Kniep1,
  3. Peter Schramm2,
  4. Uta Hanning1,
  5. Fabian Flottmann1,
  6. Tobias Faizy1,
  7. Michael Schönfeld1,
  8. Lukas Meyer1,
  9. Gerhard Schön3,
  10. Linda Aulmann2,
  11. Björn Machner4,
  12. Georg Royl4,
  13. Jens Fiehler1,
  14. Andre Kemmling1,4
  1. 1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Department of Neuroradiology, University Medical Center Schleswig-Holstein Campus, Lubeck, Germany
  3. 3 Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  4. 4 Department of Neuroradiology Westpfalz-Klinikum Kaiserslautern Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr Gabriel Broocks, Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany; g.broocks{at}uke.de

Abstract

Background Benefit of thrombectomy in patients with a low initial Alberta Stroke Program Early CT Score (ASPECTS) is still uncertain. We hypothesized that, despite low ASPECTS, patients may benefit from endovascular recanalization if good collaterals are present.

Methods Ischemic stroke patients with large vessel occlusion in the anterior circulation and an ASPECTS of ≤5 were analyzed. Collateral status (CS) was assessed using a 5-point-scoring system in CT angiography with poor CS defined as CS=0–1. Clinical outcome was determined using the modified Rankin Scale (mRS) score after 90 days. Edema formation was measured in admission and follow-up CT by net water uptake.

Results 27/100 (27%) patients exhibited a CS of 2–4. 50 patients underwent successful vessel recanalization and 50 patients had a persistent vessel occlusion. In multivariable logistic regression analysis, collateral status (OR 3.0; p=0.003) and vessel recanalization (OR 12.2; p=0.009) significantly increased the likelihood of a good outcome (mRS 0–3). A 1-point increase in CS was associated with 1.9% (95% CI 0.2% to 3.7%) lowered lesion water uptake in follow-up CT .

Conclusion Endovascular recanalization in patients with ASPECTS of ≤5 but good collaterals was linked to improved clinical outcome and attenuated edema formation. Collateral status may serve as selection criterion for thrombectomy in low ASPECTS patients.

  • stroke
  • brain ischemia
  • thrombectomy
  • edema
  • outcome
  • computed tomography

https://doi.org/10.1136/neurintsurg-2019-015308

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    Footnotes

    • Contributors GB: Study design. Acquisition of data. Image processing. Data analysis. Statistical analysis. Drafting the manuscript and revising it critically. HK: Data analysis. Acquisition of data. Drafting the manuscript and revising it critically. PS: Data analysis. Statistical analysis. Acquisition of data. Drafting the manuscript and revising it critically. UH: Data analysis. Statistical analysis. Acquisition of data. Drafting the manuscript and revising it critically. FF: Data analysis. Acquisition of data. Drafting the manuscript and revising it critically. MS: Data analysis. Drafting the manuscript and revising it critically. LM: Data analysis. Statistical analysis. Drafting the manuscript and revising it critically. GS: Data analysis. Statistical analysis. Drafting the manuscript and revising it critically. BM: Study design. Drafting the manuscript and revising it critically. GR: Study design. Drafting the manuscript and revising it critically. JF: Study design. Drafting the manuscript and revising it critically. AK: Study design. Acquisition of data. Image processing. Data analysis. Statistical analysis. Drafting the manuscript and revising it critically.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JF: Consultant for Acandis, Boehringer Ingelheim, Codman, Microvention, Sequent, Stryker. Speaker for Bayer Healthcare, Bracco, Covidien/ev3, Penumbra, Philips, Siemens. Grants from Bundesministeriums für Wirtschaft und Energie (BMWi), Bundesministerium für Bildung und Forschung (BMBF), Deutsche Forschungsgemeinschaft (DFG), European Union (EU), Covidien, Stryker (THRILL study), Microvention (ERASER study), Philips. AK: research collaboration agreement: Siemens Healthcare. All other authors: No conflicts.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.