Abstract
Purpose: Final ASPECTS has been shown to predict patient outcomes after endovascular therapy in stroke. The goal of this study was to compare sequential ASPECTS imaging pre-treatment and post-treatment in predicting outcome. Methods: The PICS Study is a prospective registry of clinical and imaging data in proximal artery occlusion patients treated with the Penumbra System. In multivariate analysis, variables assessed for relationship to 90 day mRS included age, gender, time to reperfusion, occlusion location, ASPECTS, and NIHSS. ASPECTS scores were assessed by a central core laboratory, blinded except for stroke side. Results: In this study, 141 patients with mean age 67.9 ± 15.6 and median admission NIHSS score 16.0 (IQR 12.0-21.0) met study criteria. Univariate predictors of 90 day mRS included age, baseline NIHSS, 7 day/discharge NIHSS as well as post-treatment ASPECTS. After adjusting for age and baseline NIHSS, post procedure ASPECTS showed a stronger relationship with good outcome (p<0.0001) than pre-treatment ASPECTS (p=0.0520). Change in ASPECTS was also a significant predictor of 90 day mRS (p=0.0046) in the multivariate analysis. Conclusion: Sequential and post procedure ASPECTS are better predictors of clinical outcome following endovascular therapy than pre-ASPECTS. Final infarct volume quantified using ASPECTS serves as a surrogate biomarker for long-term functional outcome.
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