Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy

Barber, Philip A.; Demchuk, Andrew M.; Zhang, Jinjin; Buchan, Alastair

doi:10.1016/s0140-6736(00)02237-6

Cited by 2,175 publications

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“…NCCT ASPECTS as a measure of infarct size is associated with functional outcome (Barber et al. 2000). CTA goes beyond the mere visualization of the vessel occlusion and provides additional parameters, which are proven outcome predictors: CTA‐SI ASPECTS (Bhatia et al.…”

Section: Discussionmentioning

confidence: 99%

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Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

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Section: Discussionmentioning

confidence: 99%

“…We estimated the effect of the clinical and radiological variables on outcome with an ordinal logistic regression (proportional odds) model (Bender and Benner 2000; Saver 2007), which considers the whole range of the mRS. Variable selection was data driven.…”

Section: Methodsmentioning

confidence: 99%

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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“…Early ischemic changes such as focal hypo-attenuation, loss of gray-white matter differentiation, and sulci effacement were quantified using the ASPECTS scoring [3] in baseline NCCT. In CTA-SI, regions of diminished contrast enhancement of the parenchyma relative to the contralateral hemisphere were scored as abnormal [7].…”

Section: Methodsmentioning

confidence: 99%

Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

et al. 2016

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Esta es la versión de autor del artículo publicado en: This is an author produced version of a paper published in:Neuroradiology 58.5 (2016) In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SIASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %).Conclusions CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies.Keywords Ischemic stroke . CT-angiography . IntroductionEarly recanalization of the occluded vessel is crucial in improving the prognosis of acute ischemic stroke. However, despite achieving successful and prompt . However, the usefulness of this score for treatment decisions has been debated as it has modest inter-rater reliability, and the majority of recent trials of MT excluded patients with poorer baseline ASPECTS score [6]. ASPECTS on CT angiography source images (CTA-SIASPECTS) has been shown to be a more accurate predictor of outcome and final infarct volume in acute ischemic stroke [7,8]. CTA is recommended for the assessment of site of occlusion and vessel anatomy of acute stroke patients who are potential candidates for endovascular treatment [9], CTA data being available in the majority of these patients during their initial evaluation. The aim of this study is to assess whether baseline CTA-SI-ASPECTS might help predict response to treatment and can reliably predict futile recanalization in patients undergoing reperfusion therapies; the intention being to find a reliable tool for treatment decision making.

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“…Patients with cerebral events that occur during treatment must also be re‐scanned to identify potential secondary bleeding. Local site reporting of scans is recorded; all scans are also uploaded over the Internet for independent adjudication using a validated structured classification system [as used in IST‐3 and Efficacy of Nitric Oxide in Stroke trial (ENOS)] 45, 46, 47, 48 and masked to treatment.…”

Section: Methodsmentioning

confidence: 99%

Safety and Efficacy of Intensive vs. Guideline Antiplatelet Therapy in High-Risk Patients with Recent Ischemic Stroke or Transient Ischemic Attack: Rationale and Design of the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) Trial (ISRCTN47823388)

2015

International Journal of Stroke

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RationaleThe risk of recurrence following a stroke or transient ischemic attack is high, especially immediately after the event.HypothesisBecause two antiplatelet agents are superior to one in patients with non‐cardioembolic events, more intensive treatment might be even more effective.Sample size estimatesThe sample size of 4100 patients will allow a shift to less recurrence, and less severe recurrence, to be detected (odds ratio 0·68) with 90% power at 5% significance.Methods and design Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (ISRCTN47823388) is comparing the safety and efficacy of intensive (combined aspirin, clopidogrel, and dipyridamole) vs. guideline antiplatelet therapy, both given for one‐month. This international collaborative parallel‐group prospective randomized open‐label blinded‐end‐point phase III trial plans to recruit 4100 patients with acute ischemic stroke or transient ischemic attack. Randomization and data collection are performed over a secure Internet site with real‐time data validation and concealment of allocation. Outcomes, serious adverse events, and neuroimaging are adjudicated centrally with blinding to treatment allocation.Study outcomeThe primary outcome is stroke recurrence and its severity (‘ordinal recurrence’ based on modified Rankin Scale) at 90 days, with masked assessment centrally by telephone. Secondary outcomes include vascular events, functional measures (disability, mood, cognition, quality of life), and safety (bleeding, death, serious adverse events).DiscussionThe trial has recruited more than 50% of its target sample size (latest number: 2399) and is running in 104 sites in 4 countries. One‐third of patients presented with a transient ischemic attack.

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Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy

Cited by 2,175 publications

References 14 publications

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

Safety and Efficacy of Intensive vs. Guideline Antiplatelet Therapy in High-Risk Patients with Recent Ischemic Stroke or Transient Ischemic Attack: Rationale and Design of the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) Trial (ISRCTN47823388)

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