Abstract Details

Title New Tools to Improve Prediction of Clinical Outcomes After Endovascular Therapy for Patients with Large Infarct Core

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S44 - Evidence-based Stroke Interventions and Prognostic Tools (1:48 PM-2:00 PM)

Poster/Presentation
Number 005

Objective

To evaluate two novel non-contrast CT (NCCT) biomarkers—Net Water Uptake (NWU) and the Visual Hypodensity Score (VHS)—for predicting disability outcomes for patients with large infarct core (LIC) undergoing endovascular therapy (EVT).

Background

Recent trials have shown that EVT can improve outcomes for patients with LIC. However, current imaging methods including the Alberta Stroke Program Early CT Score (ASPECTS) and CT Perfusion are limited by availability, inconsistency, and reliance on expert interpretation.

Design/Methods

From a prospectively collected multicenter registry, we included patients with anterior circulation large vessel occlusion and LIC (ASPECTS 0-5) who underwent EVT. Blinded raters scored ASPECTS and VHS from NCCT, and NWU was computed with an automated algorithm. Primary outcome was prediction of 90-day disability outcome (mRS 0-3 versus 4-6). Multivariable logistic regression was used, adjusting for age, NIHSS, IV thrombolysis, time from last-known-well to groin puncture (LKW to GP), occlusion location, and TICI.

Results Among 114 patients, median age was 65 [IQR 53–75], median NIHSS 19 [IQR 16–22], and median LKW–GP 355 minutes [IQR 222–761]; 35.1% received IV thrombolysis, and 82.5% achieved TICI 2b–3. Interrater reliability was fair for ASPECTS (κ=0.31) and VHS (κ=0.24). In multivariable regression, ASPECTS (OR 0.84, p=0.16) and VHS (OR 1.11, p=0.17) were not significantly associated with outcome, whereas NWU in the M3 region was (OR 1.30, p=0.02). ROC curves were similar across methods (AUC 0.750 vs 0.739 vs 0.750). NWU also correlated with elapsed time from symptom onset (beta coefficient 36.6, p=0.01) and effectively replaced this variable in prediction models.

Conclusions

In LIC patients undergoing EVT, NCCT-ASPECTS and VHS showed limited predictive value. NWU was independently associated with both 90-day outcome and time from onset. These findings support further validation of NWU as an improved, automated screening tool for EVT.

Authors/Disclosures
Demi K. Waworuntu PRESENTER	Ms. Waworuntu has nothing to disclose.
Omair Ul Haq Lodhi, MBBS (University of Minnesota)	Dr. Lodhi has nothing to disclose.
Alex Phan, Research Associate	Mr. Phan has nothing to disclose.
Monica Mallavarapu	Ms. Mallavarapu has nothing to disclose.
Ritesh Bajaj, MBBS	Dr. Bajaj has nothing to disclose.
Hyun Kim, MD	Dr. Kim has nothing to disclose.
Sergio Salazar-Marioni, MD (The University of Texas Health Science Center)	Dr. Salazar-Marioni has nothing to disclose.
Luca Giancardo	Luca Giancardo has received personal compensation for serving as an employee of AWS. Luca Giancardo has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rutgers University. Luca Giancardo has received intellectual property interests from a discovery or technology relating to health care. Luca Giancardo has received intellectual property interests from a discovery or technology relating to health care.
Shayan Shams, PhD	Prof. Shams has nothing to disclose.
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Sushanth R. Aroor, MD	Dr. Aroor has stock in Gravity.
Jerome Jeevarajan	Mr. Jeevarajan has nothing to disclose.

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