Abstract WP74: Automated Measurement of Cerebral Atrophy and Outcome in Endovascular Thrombectomy

Abstract

Background and Purpose: Methods of identifying ischemic stroke patients with a greater probability of poor outcome following endovascular thrombectomy (EVT) might improve shared treatment decision-making between patients, families and physicians. Visually-graded cerebral atrophy is associated with worse functional outcome following EVT. We used an objective, automated method to measure cerebral atrophy and investigated whether this was associated with functional outcome in EVT patients. Methods: Consecutive EVT patients from a single-center registry were studied. CT brain scans were segmented with a combination of a validated U-Net and Hounsfield unit thresholding. Intracranial cerebrospinal fluid (CSF) volume was used as a marker of cerebral atrophy and calculated as a proportion of total intracranial volume. The primary outcome was functional independence, defined as a 3-month modified Rankin Scale (mRS) score of 0-2. Results: 360 EVT patients were included. Functional independence was achieved in 204 (56.7%) patients. The mean±SD CSF volume was 9.0±4.7% of total intracranial volume. Multivariable regression demonstrated that increasing CSF volume was associated with reduced functional independence (OR=0.65 per 5% increase in CSF volume; 95% CI, 0.48- 0.89; P=0.007) and higher 3-month mRS scores (common OR=1.59 per 5% increase in CSF volume; 95% CI, 1.05-2.41; P=0.03). Conclusions: Cerebral atrophy determined by automated measurement of intracranial CSF volume is associated with functional outcome in patients undergoing EVT. If validated in future studies, this simple, objective, and automated imaging marker could potentially be incorporated into decision-support tools in order to improve shared treatment decision making.