Abstract Details

Title ASPECTS Scoring Applied to CTA Source Images is Predictive of Final Infarct Volume and Good Functional Recovery

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S60 - Cerebrovascular Imaging and Biomarkers (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Objective To assess the ability of ASPECTS scoring applied to CTA source images (CTA-SI) to predict final infarct volume (FIV) and clinical outcome following endovascular thrombectomy (EVT).

Background CTP is increasingly used to assess EVT candidacy. Unfortunately, availability of this advanced neuroimaging technique is not widespread, and this can lead to over-triage to EVT-capable centers.

Design/Methods We reviewed data from consecutive patients undergoing EVT at our institution for anterior circulation occlusion between 01/14–01/19. We recorded demographics, comorbidities, NIHSS, treatment times, and outcome as defined by mRS (0-2 = good outcome). Cerebrovascular images were assessed by outcome-blinded raters and collateral score, TICI score, FIV, and both CT and CTA-SI ASPECTS scores were noted. Patients were grouped by ASPECTS score into low (0-4), intermediate (5-7), and high (8-10) for some analyses. FIV was predicted using a linear regression with NIHSS, good reperfusion (TICI 2b/3), collateral score, CT-to-groin puncture, CT and CTA-SI ASPECTS as independent variables. After excluding those with baseline mRS≥2, a binary logistic regression was performed including covariates of age, NIHSS, good reperfusion, and diabetes (factors significant at p<0.05 on univariate analysis) to assess the impact of CTA-SI ASPECTS group on outcome.

Results Analysis included 137 patients for FIV and 102 for outcome analysis. Linear regression found CTA-SI ASPECTS (Beta -10.8, p=0.002), collateral score (Beta -42.9, p=0.001) and good reperfusion (Beta 72.605, p=0.000) were independent predictors of FIV. Relative to the low CTA-SI ASPECTS group, the high CTA-SI ASPECTS group was more likely to have good outcome (OR 3.75 [95% CI 1.05-13.3]; p=0.041). CT ASPECTS was not predictive of FIV or good outcome.

Conclusions In those undergoing EVT for anterior circulation occlusion, CTA-SI ASPECTS is predictive of both FIV and functional outcome, while CT ASPECTS predicts neither. CTA-SI ASPECTS holds promise as a lower-cost, more widely available option for triage of patients with large vessel occlusion.

Authors/Disclosures
Joseph F. Carrera, MD PRESENTER	Dr. Carrera has nothing to disclose.
	No disclosure on file
	No disclosure on file
Andrew M. Southerland, MD, FAAN (University of Virginia, Dept of Neurology)	Dr. Southerland has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Plaintiffs and Defense Cases related to Stroke and Vascular Neurology.. The institution of Dr. Southerland has received research support from American Heart Association. The institution of Dr. Southerland has received research support from NIH. The institution of Dr. Southerland has received research support from Abbvie Pharmaceuticals, Inc.. Dr. Southerland has received intellectual property interests from a discovery or technology relating to health care. Dr. Southerland has received intellectual property interests from a discovery or technology relating to health care.
Bradford B. Worrall, MD, MSc, FAAN (University Of Virginia Health System)	The institution of Dr. Worrall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Worrall has received research support from NIH.

��ɫ��

��ɫ��