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Vascular imaging findings may determine ASPECTS decay
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Collateral blood flow, stroke severity and proximal vascular occlusion are the main determinants of the Alberta Stroke Program Early CT Score, or ASPECTS, in patients with ischemic stroke transferred for thrombectomy, according to data published in JAMA Neurology.
Patients with an initially favorable imaging profile as determined by ASPECTS demonstrated infarct progression when transferred from a referring hospital to a thrombectomy-capable stroke center, according to a study from Gregoire Boulouis, MD, MSc, of the Stroke Research Center at Massachusetts General Hospital and Harvard Medical School, and colleagues.
“The ability to determine infarct evolution has the potential to allow optimized resource use within stroke networks by better selecting patients most likely to remain eligible and limiting futile transfers for thrombectomy,” Boulouis and colleagues wrote. “We sought to determine the clinical and imaging factors associated with evolution to an unfavorable imaging profile in patients transferred from [referring hospitals] to TCSC [thrombectomy-capable stroke centers] and to specifically evaluate the influence of the adequacy of leptomeningeal flow on infarct progression of these patients.”
Boulouis and colleagues conducted an observational, single-center, retrospective cohort study of prospectively acquired data to evaluate consecutive patients transferred from referring hospitals to a tertiary care thrombectomy-capable stroke center.
Researchers retrospectively analyzed data from 316 patients with anterior circulation ischemic stroke transferred from one of 30 referring hospitals in a regional stroke network and presenting at a thrombectomy-capable stroke center between January 2010 and January 2016.
The adequacy of leptomeningeal collateral blood flow was rated as no or poor, decreased, adequate or augmented per the adapted Maas scale.
The primary outcome of the study was an ASPECTS decay, which was defined as an initial ASPECTS of 6 or higher worsening to less than 6 between referring hospital and thrombectomy-capable stroke center as determined by CT.
According to the study results, multivariable models showed higher NIH Stroke Scale score, lower ASPECTS at baseline, and no or poor collateral blood vessel status were associated with ASPECTS decay, with the strongest association being for collateral blood vessel status (adjusted OR = 5.14 95% CI, 2.2-12.7).
Boulouis and colleagues found similar results after stratification by vessel occlusion level.
“Our study provides important new information about the nature of infarct progression on CT and the factors associated with infarct growth for patients transferred to the [thrombectomy-capable stroke center],” the researchers wrote. “Although ‘time is brain’ is a frequent phrase in acute stroke care, each patient has a different rate of stroke evolution as a result of factors such as adequacy leptomeningeal collateral blood vessels.” – by Dave Quaile
Disclosure: The authors report no relevant financial disclosures.
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