Abstract Details

Title Non-contrast CT ASPECTS versus CT Perfusion for Patients with Large Infarct Core Undergoing EVT

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-011

Objective We aimed to assess how Alberta Stroke Program Early CT Score (ASPECTS) and CT perfusion (CTP) core infarct volume correlate in patients undergoing large-core endovascular therapy (EVT), and which modality performs better for outcome prediction.

Background The ASPECTS from non-contrast CT (NCCT) and CTP estimates have been used in recent trials to triage patients with large vessel occlusion (LVO) for EVT. Recent EVT trials demonstrated that patients with large infarct core (ASPECTS 0–5) can still benefit from EVT. The reliability and upper limit of CTP core volume estimates in this population remain unclear.

Design/Methods From a multicenter, prospectively collected registry, consecutive patients with pre-treatment large core infarct defined by NCCT ASPECTS and CTP who underwent EVT were included. Baseline characteristics were compared between good versus poor outcome (modified Rankin Score 0–3 vs 4–6). ASPECTS–CTP correlation was assessed with Spearman’s coefficient. Three multivariable logistic regression models (ASPECTS-based, CTP-based, combined) evaluated predictors of poor outcome, with discrimination assessed by AUROC and DeLong test, further validated by 300 bootstrap resamples.

Results Among 64 patients, median age was 64 years, 56.2% were female, and median NIHSS was 18 [IQR 15–22]. Poor outcome patients were older and had larger CTP cores, while other factors did not differ. CTP core volume was frequently underestimated but negatively correlated with NCCT ASPECTS (ρ = –0.459, p < 0.001). On multivariable regression, age and CTP core volume independently predicted poor 90-day outcome. Final AUROCs were above 0.8, and optimism-corrected AUROCs remained high (0.787–0.840) after bootstrap validation.

Conclusions

For patients who underwent EVT for large core infarct, the ASPECT score showed a significant negative correlation with CTP core volume. Multivariable regression revealed no significant difference in outcome discrimination between ASPECTS, CTP, or their combination when predicting 90-day mRS adjusted for confounders. Age and CTP core volume were independent predictors of poor outcome.

Authors/Disclosures
Jerome Jeevarajan PRESENTER	Mr. Jeevarajan has nothing to disclose.
Roohan Aamir	Mr. Aamir has nothing to disclose.
Syed Shams	Mr. Shams has nothing to disclose.
Abigail Irwin, BS	Miss Irwin has nothing to disclose.
Demi K. Waworuntu	Ms. Waworuntu has nothing to disclose.
Monica Mallavarapu	Ms. Mallavarapu 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.

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