Abstract Number: LBA14 Incidence of Intracranial Hemorrhage & Clinical Outcomes in Fast Versus Slow Progressors as per ASPECTS

Abstract

Introduction Heterogeneity of collateralization in patients with acute ischemic stroke (AIS) is a marker of fast versus slow progression of penumbral consumption and infarct expansion. Our aim was to evaluate the relationship between time‐dependent stroke progression and incidence of intracranial hemorrhage (ICH) and acute neurological deficits. Methods Retrospective chart review of patients presenting with anterior circulation large vessel occlusion (LVO)‐associated AIS at our comprehensive stroke center with 24 hours last known normal (LKN) who underwent endovascular thrombectomy (EVT) without intra‐arterial thrombolytics or non‐thrombolytics were included. We used Alberta Stroke Program Early CT Score (ASPECTS) on initial non‐contrast CT to identify slow versus fast progressors. ASPECTS < = 7 was defined as fast progressor. Subgroup analysis was performed based on LKN < 3 hours, 3–9 hours, and 9–24 hours. We evaluated rate of hemorrhagic transformation using ECASS‐3 criteria and determined change in NIHSS from baseline to discharge. Mann‐Whitney U test and Fisher exact test statistic with Social science statistics software used for data analysis. Results From September 2019 to December 2021, out of 268 subjects who underwent EVT, 48 met inclusion criteria. Mean age was 65.29 (95% CI 61.32, 69.27), and median presenting NIHSS was 16 (95% CI 14.39, 18.40). Mean ASPECTS was 7.71 (95% CI 7.21, 8.20). There was significant difference is hemorrhagic transformation rate between ASPECTS >7 and < = 7 (Fisher value = 0.018). Sample size was not large enough to perform subgroup analysis based on last known normal. However, there was a trend towards increase in hemorrhagic transformation rate with greater time from last known well at same ASPECTS score. Slow progressors also had a significant improvement in presenting and discharge NIHSS as compared to fast progressors (z‐score is ‐3.10, p‐value is 0.002). Conclusions Our study suggests that ASPECTS score as assessed in different time windows to differentiate fast versus slow progressors is not only a predictor of clinical outcome, but also independently associated with risk of hemorrhagic transformation. Larger, prospective studies are needed to validate our results.