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Ischemic Stroke
Case series
Predictive value of CT angiography source image ASPECTS in patients with anterior circulation acute ischemic stroke after endovascular treatment: ultimate infarct size and clinical outcome
  1. Jung-Soo Park1,
  2. Jong Myong Lee1,
  3. Hyo-Sung Kwak2,
  4. Gyoung Ho Chung2
  1. 1Departments of Neurosurgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
  2. 2Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
  1. Correspondence to Professor Hyo-Sung Kwak, Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561-712, Republic of Korea; kwak8140{at}jbnu.ac.kr

Abstract

Background and purpose The objective of this study was to investigate the predictive value of computed tomographic angiography (CTA) source image Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcome and final infarction extent after endovascular treatment (EVT) in patients with acute ischemic stroke (AIS).

Methods All eligible patients from January 2014 to March 2018 undergoing EVT due to anterior circulation AIS were retrospectively reviewed. The baseline ASPECTS on initial noncontrast CT (NCCT) and the CTA source image were compared with the follow-up MR diffusion-weighted imaging (DWI) ASPECTS. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of CTA ASPECTS for prediction of final infarct extent and good clinical outcome.

Results Our sample included a total of 122 eligible patients (64 males, mean age 70 years) with a median baseline National Institute of Health Stroke Scale (NIHSS) score of 12. Baseline ASPECTS on the CTA source image correlated with follow-up MR DWI ASPECTS better than NCCT ASPECTS (P<0.001). ROC curve analysis revealed baseline CTA ASPECTS (area under the curve [AUC] =0.74, 95% CI: 0.65 to 0.83, P<0.001) can better predict favorable functional outcome than NCCT ASPECTS (AUC=0.64, 95% CI: 0.54 to 0.74, P=0.008). Baseline NIHSS score <15, CTA ASPECTS≥8, and successful recanalization were independent predictors of good clinical outcomes.

Conclusion The ASPECTS on the CTA source image provides more information in the prediction of good clinical outcome and final infarction size than NCCT in patients with AIS treated with EVT.

  • ct angiography
  • stroke

https://doi.org/10.1136/neurintsurg-2018-014359

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    Footnotes

    • Contributors The four authors are justifiably credited with authorship, according to the authorship criteria. J-SP wrote the manuscript. H-SK, JML, and GHC critically reviewed the manuscript. All authors approved the final manuscript.

    • Funding This paper was supported by Fund of Biomedical Research Institute, Chonbuk National University Hospital.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Chonbuk National University Hospital.

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

    • Data sharing statement A technical appendix, statistical code, and dataset are available from the corresponding author. Participants gave informed consent for data sharing.