Abstract TMP4: Higher Pretreatment Computed Tomography Angiography Source Image (CTA-SI) ASPECTS Score Predicts Better Outcome After Intra-arterial Therapy

Abstract

Introduction: Intra-arterial (IA) therapies are becoming prevalent in acute stroke management. Despite greater success rates of recanalization and newer IA therapies, outcomes have shown mixed improvements. Patient selection remains a key element in targeting those who are more likely to benefit from therapy. The Alberta Stroke Program Early CT Score (ASPECTS) is a 10-point quantitative topographic computed tomography (CT) scan score that has been used to estimate the size of cerebral infarction. The relationship between CTA-SI ASPECTS on IA therapy outcomes in acute stroke patients has not been reported. Hypothesis: Higher CTA-SI ASPECTS scoring in IA therapy patients will yield favorable 30-day outcomes. Methods: All patients with acute stroke who underwent CT, CTA and IA therapy between July 2006 and June 2012 were included in this study. Demographic, radiological and clinical data including admission NIHSS and 30 day modified rankin score (mRS) was collected. 30-day data was pooled into an mRS of 1-3 marking favorable outcome and 4-6 marking unfavorable outcome. CTA-SI ASPECT scores were binned into one of three scoring groups: 8-10, 5-7 and 1-4. Data were analyzed by t-test and chi-square. Results: Eighty one (41 females, mean age 69.1 +/- 15 years) patients underwent CT, CTA and IA therapy and had a 30-day mRS assessment. Mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 15.6 (+/- 6.7). 10 patients had a CTA-SI ASPECT score of 1-4, 32 had a score of 5-7 and 39 had a score of 8-10. All 10 with a CTA-SI ASPECT score of 1-4 had an unfavorable outcome after IA therapy. 3 patients (9.38%) with a score of 5-7 and 13 patients (33.33%) with a score of 8-10 had a favorable outcome after IA therapy. Patients with higher CTA-SI scores were more likely to have a better outcome at 30 days after IA therapy (LR 10.95, p< .004). Conclusions: This study suggests that patients with higher CTA-SI ASPECT scores have more favorable outcomes after IA therapy. Further studies are needed to assess the clinical benefit of using CTA-SI ASPECTS as a selection tool for IA therapy.