The role of ASPECTs in patient selection for endovascular therapy – CTA source images versus noncontrast CT

Özdemi̇r, Atilla Özcan; Eryıldız, Ezgi Sezer; Akarsu, Fatma Ger; Kocabaş, Zehra Uysal; Aykaç, Özlem

doi:10.1016/j.jocn.2019.10.006

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…26 Ozdemir et al. 27 found CTASI-ASPECTS in patient selection for thrombectomy seemed to be more useful than NCCT-ASPECTS. On the other hand, for large ischemic core volume, different thresholds of ischemic core were also supposed to be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis

Jiang

Wang

et al. 2021

Interv Neuroradiol

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Objective We compared outcomes and adverse events of thrombectomy versus medical management in acute ischemic stroke (AIS) patients with baseline large infarct core. Methods We searched Ovid MEDLINE(R) ALL, Cochrane Library Clinical Controlled Trials and EMBASE from inception to January 2021 for studies comparing thrombectomy and medical management alone in AIS patients who had ASPECTS <=7 or ischemic core volume >=50 ml. Imaging modalities to valuate ASPECTS and core volume were without restriction. The functional outcome was measured by mRS (modified Rankin Scale) score 0-2 at 90 days or discharge. The safety end point included the rates of mortality and sICH (symptomatic intracranial hemorrhage) or PH2 (parenchymal hematoma type 2). Results Fourteen studies with a total of 2547 patients (thrombectomy n = [1197]; medical care alone [n = 1350]) fulfilled our criteria. As for patients with low ASPECTS, pooled results indicated a higher odds of good functional outcome (OR = 3.47; 95% CI 1.99 to 6.07; P < 0.0001, I2=66%) and a lower risk of mortality (OR = 0.62; 95% CI 0.46 to 0.83; P = 0.001, I2=32%) in thrombectomy group compared with no thrombectomy group, but the risk of sICH or PH2 did not differ between two groups. As for patients with large core volume, both functional outcome and safety end point between two groups showed no statistically significant difference. Conclusion Thrombectomy remained safe and effective by careful selection in patients with low ASPECTS. More studies were warranted to explore contraindications for mechanical thrombectomy in AIS patients, especially in patients with large core volume.

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Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis

Jiang

Wang

et al. 2021

Interv Neuroradiol

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“…In addition, CTASI-ASPECTS-HU was a better discriminator than NCCT-ASPECTS-HU in predicting HT or PH, and it was the only significantly different variable in distinguishing between HI and PH. Previous studies have shown that CTASI provides infarct core estimates equivalent to diffusion-weighted images or the extent of final infarcts [19, 20] and correlate best with CBV on CTP [21, 22]. Therefore, CTASI is more advantageous than NCCT in determining the extent of ischemic core.…”

Section: Discussionmentioning

confidence: 99%

ASPECTS-Based Attenuation Changes on CT Angiography as an Imaging Biomarker to Predict Hemorrhagic Transformation in Acute Ischemic Stroke

Cheng

Shi

et al. 2022

Cerebrovasc Dis

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Introduction: Imaging-based early warning indicators and feasible stratification of acute ischemic stroke (AIS) patients with hemorrhagic transformation (HT), especially high-risk patients with parenchymal hematoma (PH), are crucial in determining subsequent treatment strategies. This study combined automated ASPECTS software with noncontrast CT (NCCT) and CTA source image (CTASI) attenuation changes using Hounsfield unit (HU) values to predict HT and PH in patients with AIS. Materials and Methods: We retrospectively enrolled 172 consecutive patients with anterior circulation large-vessel occlusion between 2016 and 2020. Univariate and multivariate logistic regression and receiver operating characteristic (ROC) analyses were used to investigate the relationship between NCCT and CTASI-ASPECTS-HU, as well as other clinical and radiological parameters of HT and PH. Univariate and multivariate logistic regression analyses were performed to explore risk factors for HT or PH, and an ROC curve was used to evaluate their diagnostic values. Results: A multivariate analysis showed that CTASI-ASPECTS-HU and NIHSS score were independent predictors of HT (CTASI-ASPECTS-HU: odds ratio (OR), 2.22; 95% CI, 1.01–4.92; NIHSS: OR, 1.07; 95% CI, 1.02–1.13) and PH (CTASI-ASPECTS-HU: OR, 6.51; 95% CI, 2.29–18.50; NIHSS: OR, 1.07; 95% CI, 1.01–1.13). According to ROC analysis, CTASI-ASPECTS-HU >0.09 identified HT (area under the curve, 0.70; sensitivity, 70.15%; specificity, 61.90%), and CTASI-ASPECTS-HU >0.10 identified PH (area under the curve, 0.79; sensitivity, 76.19%; specificity, 73.33%). The area under the curve for predicting HT or PH increased when CTASI-ASPECTS-HU was combined with NIHSS score (HT: area under the curve, 0.74; sensitivity, 73.13%; specificity, 70.48%; PH: area under the curve, 0.81; sensitivity, 85.71%; specificity, 72.38%). Conclusion: CTASI-ASPECTS-HU is a reliable radiological predictor of HT and PH in patients with AIS. Its predictive efficacy is moderately improved when combined with NIHSS score.

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“…The hypoattenuation is visually identified as a distinct difference between the normal and the abnormal brain. [9][10][11]18 (Figure 2)…”

Section: Discussionmentioning

confidence: 99%

ASPECTS as a clinical outcome marker for MCA infarction treated with thrombolytic therapy: Non-contrast CT versus CTA source images

AKARSU¹,

ERYILDIZ²,

AYKAÇ³

et al. 2022

NeuroAsia

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Background & Objective: Computed tomography angiography (CTA) in acute stroke has been widely used to demonstrate arterial occlusion. Alberta Stroke Program Early CT Score (ASPECTS) is used to detect early ischemic signs in non-contrast computed tomography (NCCT) in the middle cerebral artery region. We hypothesized that computed tomography angiography source image (CTA-SI) is superior to NCCT in predicting final infarct volume, 24 hour National Institutes of Health Stroke Scale (NIHSS) score and 90-day clinical outcome. Methods: Patients who had an acute ischemic stroke due to middle cerebral artery (MCA) occlusion and treated with tissue plasminogen activator (tPA) were retrospectively evaluated. ASPECTS was evaluated by two experienced stroke neurologists in acute NCCT, CTA-SI, and follow up imaging. The final ASPECTS was compared with the mean baseline ASPECTS of NCCT and CTA-SI. The relation of both scores with 24-hour NIHSS and clinical outcome was compared. The Modified Rankin Scale (mRS) was utilized to evaluate the 90-day outcomes. mRS score of 0-2 was considered a “good outcome”. Results: Fifty-three patients were evaluated. We observed a significant relation among CTA-SI ASPECTS and after treatment 24hr ASPECTS (y= -3.9 + 1.4 x; 95% CI, -7.6 to -0.2) (y= -26.04 + 3.5 x; CI, -41 to -10). The median baseline 24-hr NHISS was 6 (0 - 22). We found a better correlation between CTA-SI ASPECTS and 24-hr NHISS (y= 363.06 + -37.03 x; CI, -148 to 864) than between NCCT ASPECTS and 24h NHISS (y=529.80 + -62.55 x; CI, 180 - 829). Median 90 days mRS score was 2 (0 - 6). According to Deming regression analysis, the CTA-SI ASPECTS (y= 76.10 + -7.69 x; 95% CI, -36 to 188) was more consistent with the 90 day mRS compared to NCCT ASPECTS (y=149.86 + -17.67 x; 95% CI, 23 - 267) CTA-SI was superior in predicting 24hr NIHSS and day 90 mRS compared to NCCT ASPECTS. Conclusion: Prediction of CTA-SI ASPECTs is better than NCCT ASPECTs at 24hr NIHSS, 3-month mRS and final infarct size in acute ischemic stroke patients treated with tPA.

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The role of ASPECTs in patient selection for endovascular therapy – CTA source images versus noncontrast CT

Cited by 7 publications

References 28 publications

Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis

Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis

ASPECTS-Based Attenuation Changes on CT Angiography as an Imaging Biomarker to Predict Hemorrhagic Transformation in Acute Ischemic Stroke

ASPECTS as a clinical outcome marker for MCA infarction treated with thrombolytic therapy: Non-contrast CT versus CTA source images

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