PT  - JOURNAL ARTICLE
AU  - Spiotta, Alejandro M
AU  - Vargas, Jan
AU  - Hawk, Harris
AU  - Turner, Raymond
AU  - Chaudry, M Imran
AU  - Battenhouse, Holly
AU  - Turk, Aquilla S
TI  - Impact of the ASPECT scores and distribution on outcome among patients undergoing thrombectomy for acute ischemic stroke
AID  - 10.1136/neurintsurg-2014-011195
DP  - 2015 Aug 01
TA  - Journal of NeuroInterventional Surgery
PG  - 551--558
VI  - 7
IP  - 8
4099  - http://jnis.bmj.com/content/7/8/551.short
4100  - http://jnis.bmj.com/content/7/8/551.full
SO  - J NeuroIntervent Surg2015 Aug 01; 7
AB  - Introduction This study investigates whether the Alberta Stroke Program Early CT Score (ASPECTS) quantification is associated with outcome following mechanical thrombectomy.Objective To determine whether preintervention non-perfect ASPECT scores involving cortical or subcortical regions and the side of the non-perfect ASPECT score affects outcomes.Methods A retrospective review of a prospectively maintained database of patients with acute ischemic stroke involving the anterior circulation who underwent thrombectomy between May 2008 and August 2012 at a single tertiary care center. The device for mechanical thrombectomy used was the penumbra aspiration system (Penumbra Inc, Alameda, California, USA) and the Solitaire stent retriever (ev3, Irvine, California, USA). A ‘blinded’ neuroradiologist obtained ASPECTS quantification and noted each region demonstrating early changes.Results 149 patients (51.7% female, mean age 66.1±15.1 years) were included with an average National Institutes of Health Stroke Scale of 16.2±6.7. Patients with non-perfect ASPECT scores on pretreatment imaging were more likely to have a hemorrhagic conversion (p=0.04) evident on post-procedure CT. However, functional outcomes were the same. Patients with both cortical and basal ganglia non-perfect ASPECT scores were more likely to be in a persistent vegetative state or expire. No differences were identified in outcome among patients with left- versus right-sided infarcts affecting the basal ganglia or cortical regions.Conclusions These findings support a strategy of selecting candidacy for thrombectomy that does not exclude patients with non-perfect ASPECT scores involving either the basal ganglia or cortical regions. Outcomes were identical among patients with no non-perfect ASPECT scores and those with cortical or subcortical infarcts, despite a higher incidence of hemorrhagic conversion found among those with non-perfect ASPECT scores.