Post-stroke ASPECTS predicts outcome after thrombectomy

Leker, Ronen R.; Honig, Asaf; Filioglo, Andrei; Simaan, Naaem; Gomori, John M.; Cohen, José E.

doi:10.1007/s00234-020-02576-9

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…ASPECTS, unlike the precise infarct volume, can be readily evaluated on follow-up CT and has proven to be a valuable outcome predictor. This finding aligns with studies by Leker et al, who demonstrated that post-stroke ASPECTS predicts outcomes post-thrombectomy 49 . Our findings align with those from Monteiro et al who predicted the functional outcome three months post-stroke in 425 patients treated with recombinant tissue plasminogen activator (rtPA) 8 .…”

Section: Discussionsupporting

confidence: 92%

Uncertainty-aware deep learning for trustworthy prediction of long-term outcome after endovascular thrombectomy

Martín Vicario,

Rodríguez Salas,

Maier

et al. 2024

Sci Rep

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Acute ischemic stroke (AIS) is a leading global cause of mortality and morbidity. Improving long-term outcome predictions after thrombectomy can enhance treatment quality by supporting clinical decision-making. With the advent of interpretable deep learning methods in recent years, it is now possible to develop trustworthy, high-performing prediction models. This study introduces an uncertainty-aware, graph deep learning model that predicts endovascular thrombectomy outcomes using clinical features and imaging biomarkers. The model targets long-term functional outcomes, defined by the three-month modified Rankin Score (mRS), and mortality rates. A sample of 220 AIS patients in the anterior circulation who underwent endovascular thrombectomy (EVT) was included, with 81 (37%) demonstrating good outcomes (mRS$$\le$$ ≤ 2). The performance of the different algorithms evaluated was comparable, with the maximum validation under the curve (AUC) reaching 0.87 using graph convolutional networks (GCN) for mRS prediction and 0.86 using fully connected networks (FCN) for mortality prediction. Moderate performance was obtained at admission (AUC of 0.76 using GCN), which improved to 0.84 post-thrombectomy and to 0.89 a day after stroke. Reliable uncertainty prediction of the model could be demonstrated.

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Section: Discussionsupporting

confidence: 92%

Uncertainty-aware deep learning for trustworthy prediction of long-term outcome after endovascular thrombectomy

Martín Vicario,

Rodríguez Salas,

Maier

et al. 2024

Sci Rep

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“…Our results showed that pc-ASPECTS was significant in the univariate analysis, but it was not predictable in the multivariate regression analysis. As reported in previous studies, the roles of pc-ASPECTS are heterogeneous in prognostic prediction, and the optimal cut-off value associated with favorable outcomes is still controversial 24–26. The heterogeneous results indicated that imaging criteria for treatment candidates need further exploration based on individual baseline characteristics such as NIHSS score, age or time to treatment, which are known as predictors of outcomes.…”

Section: Discussionmentioning

confidence: 98%

Tmax profile in computed tomography perfusion-based RAPID software maps influences outcome after mechanical thrombectomy in patients with basilar artery occlusion

Liu

Hang

Cao

et al. 2022

J NeuroIntervent Surg

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BackgroundComputed tomography perfusion (CTP) parameters have been shown to have predictive value for functional outcomes of patients with basilar artery occlusion (BAO). We report the predictive value of CTP-based software (CTP-Rapid Processing of Perfusion and Diffusion (RAPID); iSchemia View) for functional outcomes of patients with BAO after endovascular therapy (EVT).MethodsPatients with BAO who underwent EVT were retrospectively analyzed in our center from December 2019 to July 2021. Baseline characteristics and imaging parameters from non-contrast CT, CT angiography (CTA), and CTP-RAPID were collected for analysis.ResultsAmong the 55 patients enrolled in this study, 22 (40.0%) achieved a good functional outcome (modified Rankin Scale score ≤3 at 90 days). In the univariate analysis, posterior circulation Alberta Stroke Program Early CT Score, Basilar Artery on CT Angiography score, posterior circulation CTA score, posterior communicating artery deficiency, perfusion deficit volume in time to maximum (Tmax) >4 s, Tmax >6 s, and mismatch volume were associated with functional outcomes (all p<0.05). In the multivariate analysis, perfusion deficit volume in Tmax >6 s (OR 1.011 (95% CI 1.001 to 1.020)) and posterior circulation CTA score (OR 0.435 (95% CI 0.225 to 0.840)) remained independent outcome predictors (all p<0.05).ConclusionsPerfusion deficit volume in Tmax >6 s on CTP-RAPID imaging maps and basilar artery on CTA score have potential as functional outcome predictors in patients with BAO after EVT.

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“…It has been reported that postoperative indicators such as RNI, cerebral tissue reperfusion examinations, and follow-up infarct volumes could predict prognosis ( 4 , 12 , 14 , 25 , 26 ), whereas the presence of anesthesia, sedation, hyperthermia, and a “stunned brain” affects the assessment of NIHSS scores during the early postoperative period ( 27 ). Thus, RNI is generally assessed at 24 h after thrombectomy, and the follow-up of infarct volumes is performed later (generally between 24 h and 1 week) ( 14 , 25 , 26 ). The evaluation of perfusion status by CTP or MRI within 24 h after thrombolysis or thrombectomy can also predict prognosis, while recanalization cannot ( 5 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

Post-ASPECTS based on hyperdensity in NCCT immediately after thrombectomy is an ultra-early predictor of hemorrhagic transformation and prognosis

Chen

Zhang

et al. 2022

Front. Neurol.

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Background and PurposeAlmost half of the patients exhibit futile recanalization after thrombectomy; however, the early postoperative predictors of futile recanalization remain unclear. We analyzed the relationship of post-thrombectomy ASPECTS (Post-ASPECTS) with 90-day prognosis and hemorrhagic transformation (HT).MethodsWe collected data from patients with acute ischemic stroke (AIS) with anterior-circulation large vessel occlusion (ACLVO) who were treated via thrombectomy within 10 h in 3 hospitals. Successful endovascular recanalization was achieved (modified thrombolysis in cerebral ischemia [mTICI] 2b/3). Non-contrast computed tomography (NCCT) examination was performed immediately (within 1 h) after thrombectomy. Post-ASPECTS were scored based on the brain parenchymal hyperdensity in NCCT according to the ASPECTS scoring method. HT was defined according to the ECASS II classification criteria. Linear correlation, logistic regression, and receiver operating characteristic curve analyses were used to determine the influencing factors and best predictive value of 90-day prognosis, 90-day death, and HT.ResultsA total of 231 patients were enrolled. The good prognosis rate, mortality rate, and HT rate were 57.1, 9.5, and 38.3%, respectively. The Post-ASPECTS affected poor prognosis, death, and HT. The best predictive value of Post-ASPECTS for poor prognosis, death, and HT was 7. The specificities of Post-ASPECTS for predicting HT, poor prognosis, and death were 87.6% (AUC, 0.811; P < 0.001), 87.1% (AUC, 0.768; P < 0.001), and 73.7% (AUC, 0.748; P < 0.001), with positive predictive values of 74.2, 75.7, and 21.4%, respectively.ConclusionPost-ASPECTS predicted 90-day prognosis, death, and HT with high specificity and high positive predictive value in patients with AIS with ACLVO. Post-ASPECTS may be an ultra-early predictor of prognosis after thrombectomy.

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Post-stroke ASPECTS predicts outcome after thrombectomy

Cited by 10 publications

References 29 publications

Uncertainty-aware deep learning for trustworthy prediction of long-term outcome after endovascular thrombectomy

Uncertainty-aware deep learning for trustworthy prediction of long-term outcome after endovascular thrombectomy

Tmax profile in computed tomography perfusion-based RAPID software maps influences outcome after mechanical thrombectomy in patients with basilar artery occlusion

Post-ASPECTS based on hyperdensity in NCCT immediately after thrombectomy is an ultra-early predictor of hemorrhagic transformation and prognosis

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