Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke
Author
Kawiorski, Michal M.; Martínez-Sánchez, Patricia; García-Pastor, Andrés; Calleja, Patricia; Fuentes Gimeno, Blanca Eulalia

Entity
UAM. Departamento de CirugíaPublisher
Springer VerlagDate
2016-05-01Citation
10.1007/s00234-016-1652-7
Neuroradiology 58.5 (2016): 487–493
ISSN
0028-3940 (print); 1432-1920 (online)DOI
10.1007/s00234-016-1652-7Editor's Version
http://dx.doi.org/10.1007/s00234-016-1652-7Subjects
Ischemic stroke; CT-angiography; MedicinaNote
The final publication is available at Springer via http://dx.doi.org/10.1007/s00234-016-1652-7Abstract
Introduction Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization. Methods Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, timelapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability).
Results Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT+MT (39 %). Recanalization rate was 71 %,
median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3–0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5–1.2). A score ≤5 in CTA-SIASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %).
Conclusions CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies
Files in this item
Google Scholar:Kawiorski, Michal M.
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Martínez-Sánchez, Patricia
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García-Pastor, Andrés
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Calleja, Patricia
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Fuentes Gimeno, Blanca Eulalia
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Sanz-Cuesta, Borja E.
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Lourido, Daniel
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Marín, Begoña
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Díaz-Otero, Fernando
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Vicente, Agustina
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Sierra-Hidalgo, Fernando
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Ruiz-Ares, Gerardo
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Díez Tejedor, Exuperio
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Fandiño, Eduardo
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Alonso de Leciñana, María
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