BACKGROUND: The role of Alberta Stroke Program Early CT Score (ASPECTS) for thrombectomy patient selection and prognostication in late time windows is unknown.
AIMS: We compared baseline ASPECTS and core infarction determined by CT perfusion (CTP) as predictors of clinical outcome in the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE) 3 trial.
METHODS: We included all DEFUSE 3 patients with baseline non-contrast CT and CTP imaging. ASPECTS and core infarction were determined by the DEFUSE 3 core laboratory. Primary outcome was functional independence (modified Rankin Scale (mRS) ≤2). Secondary outcomes included ordinal mRS shift at 90 days and final core infarction volume.
RESULTS: Of the 142 patients, 85 patients (60%) had ASPECTS 8-10 and 57 (40%) had ASPECTS 5-7. Thirty-one patients (36%) with ASPECTS 8-10 and 11 patients (19%) with ASPECTS 5-7 were functionally independent at 90 days ( p = 0.03). In the primary and secondary logistic regression analysis, there was no difference in ordinal mRS shift ( p = 0.98) or functional independence (mRS ≤ 2; p = 0.36) at 90 days between ASPECTS 8-10 and ASPECTS 5-7 patients. Similarly, primary and secondary logistic regression analyses found no difference in ordinal mRS shift ( p = 1.0) or functional independence (mRS ≤ 2; p = 0.87) at 90 days between patients with baseline small core ( < 50 ml) versus medium core (50-70 ml).
CONCLUSIONS: Higher ASPECTS (8-10) correlated with functional independence at 90 days in the DEFUSE trial. ASPECTS and core infarction volume did not modify the thrombectomy treatment effect, which indicates that patients with a target mismatch profile on perfusion imaging should undergo thrombectomy regardless of ASPECTS or core infarction volume in late time windows.
Bibliographical noteFunding Information:
We thank the DEFUSE 3 Primary Investigators and the National Institutes of Neurological Disorders and Stroke. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02586415. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding was provided by grants from the National Institutes of Neurological Disorders and Stroke (U10NS086487 and U01NS092076).
© 2020 World Stroke Organization.
- CT perfusion
- endovascular thrombectomy
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural