Abstract Details

Title Role of CT Perfusion Parameters and Collateral Score in Predicting Outcomes in Large Vessel Occlusion Strokes Who Received Both Intravenous Alteplase and Endovascular Thrombectomy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-042

Objective The objective of this study was to assess the role of CT perfusion (CTP) parameters and collateral score in optimizing outcome prediction in patients who received alteplase and ET at our institution between 2016-18.

Background

We previously reported that older age and deterioration in NIHSS after the first 24 hours of Endovascular thrombectomy (ET) were predictive of poor outcomes in patients who received ET and intravenous (IV) alteplase. Studies have shown that addition of imaging parameters strengthens outcome prediction that is derived solely from clinical parameters.

Design/Methods In this retrospective cohort study, two (neuro)radiologists reviewed CT Angiograms for 41 LVO stroke patients who received timely IV alteplase and successful ET (TICI 2b/3 <12h). Collateral score was assigned from 0 (no collaterals) to 3 (complete collateral supply). Core, hypo-perfusion volume, mismatch volume and ratio were obtained from CTP RAPID. Death, discharge to hospice or subacute rehab was defined as poor outcome. Discharge to acute rehab or home was defined as favorable outcome. The two groups were compared by univariate analysis.

Results Of the two groups with similar baseline mean Modified Rankin Scale and admission NIH Stroke Scale, 25(61%) and 16(39%) patients had favorable and poor outcomes respectively. Neither of the CTP parameters nor collateral score was independently predictive of poor outcome. A predictive model based on age and core volume showed significant predictive ability (p= 0.0018). Majority of this prediction is from age and core volume makes a non-significant contribution to the model (p=0.087). Noteworthy, this p value is close to 0.05.

Conclusions

In this preliminary analysis, we found that collateral score and CTP parameters are not independently predictive of poor outcome. However, in combination with older age, CTP core volume may potentially predict poor outcome in LVO patients who receive both intravenous alteplase and timely ET. Larger sample-size is required to make further conclusions.

Authors/Disclosures
Saurav Das, MD (Washington University in St. Louis) PRESENTER	Dr. Das has nothing to disclose.
	No disclosure on file
	No disclosure on file
Riwaj Bhagat, MD (Conemaugh Memorial Medical Center)	Dr. Bhagat has nothing to disclose.
	No disclosure on file
Wei Liu, MD	Dr. Liu has nothing to disclose.
Kerri S. Remmel, MD, PhD (Regional Brain Institute)	Dr. Remmel has nothing to disclose.
	No disclosure on file

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