Abstract P364: Use of the Electronic Alberta Stroke Program Early CT Score Software to Guide Treatment of Patients With Acute Ischemic Stroke

Abstract

Introduction: Rapid recognition of large-vessel middle cerebral artery (lvMCA) stroke in patients with acute stroke symptoms is critical to guide thrombectomy and hemicraniectomy decisions. The Electronic Alberta Stroke Program Early CT Score (e-ASPECTS; Brainomix, LLC) is an automated, artificial intelligence software which quantifies acute ischemic volume (AIV) on CT head scans in the MCA territory. In this study, we investigate if e-ASPECTS-derived AIV could help guide treatment and predict outcomes for patients transferred from community hospitals. Hypothesis: E-ASPECTS can help identify patients that may benefit from thrombectomy or hemicraniectomy. Methods: We performed a retrospective chart review on patients age 18-90 transferred to our comprehensive stroke center (CSC) between 2013-2017. Non-contrast CT head scans performed at community hospitals prior to transfer were processed by e-ASPECTS to calculate AIV. Logistic regressions were used to test the relationship between AIV and eventual treatment (thrombectomy, hemicraniectomy). Results: 228 patient CT scans were analyzed by e-ASPECTS. In all transferred patients, higher AIV predicted patients with later confirmed lvMCA strokes (defined as an ICA or M1 occlusion; OR 1.03, CI 1.02-1.05, P<0.001). Higher AIV also trended toward thrombectomy but was not statistically significant (P=0.15). In the subgroup analysis of patients later confirmed to have lvMCA strokes, lower AIV was predictive for thrombectomy (OR 0.95, CI 0.92-0.97, P<0.001). Additionally, higher AIV predicted outcomes of malignant cerebral edema (MCE; OR 1.03, CI 1.02-1.05, P<0.001) and hemicraniectomy (OR 1.04, CI 1.00-1.07, P=0.03). Conclusions: Our study suggests that e-ASPECTS may be useful in identifying patients who would, or would not, benefit from transfer to a CSC from hospitals without thrombectomy or hemicraniectomy resources. Patients with stroke mimics or lvMCA strokes with large penumbras have lower AIVs, while patients with higher AIVs are at risk for MCE and may benefit from hemicraniectomy.