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CT perfusion core and ASPECT score prediction of outcomes in DEFUSE 3
May Kim-Tenser1, Michael Mlynash2, Maarten G Lansberg2
1Department of Neurology, 5116University of Southern California, Los Angeles, CA, USA.
Insights
Alberta Stroke Program Early CT Score (ASPECTS) did not predict thrombectomy outcomes in late windows. Patients with target mismatch profiles should receive thrombectomy regardless of ASPECTS or core infarct volume.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- The utility of the Alberta Stroke Program Early CT Score (ASPECTS) in selecting patients for thrombectomy and predicting outcomes in late time windows remains unclear.
- This study investigates the role of ASPECTS and core infarct volume in predicting outcomes for patients undergoing thrombectomy in extended timeframes.
Purpose of the Study:
- To compare baseline ASPECTS and core infarction volume (assessed by CT perfusion) as predictors of clinical outcomes in the DEFUSE 3 trial.
- To determine if ASPECTS or core infarct volume influence the effectiveness of thrombectomy in patients with ischemic stroke in late time windows.
Main Methods:
- Analysis of 142 patients from the DEFUSE 3 trial with baseline non-contrast CT and CT perfusion (CTP) imaging.
- ASPECTS and core infarction volumes were assessed by the DEFUSE 3 core laboratory.
- Primary outcome was functional independence (modified Rankin Scale score ≤2) at 90 days; secondary outcomes included ordinal mRS shift and final core infarct volume.
Main Results:
- While higher ASPECTS (8-10) showed a trend towards better functional independence (36% vs. 19%), logistic regression revealed no significant difference in functional independence (mRS ≤2) or ordinal mRS shift between ASPECTS groups (8-10 vs. 5-7) or core infarct volume groups (<50ml vs. 50-70ml).
- ASPECTS and core infarct volume did not significantly predict functional independence or ordinal mRS shift at 90 days.
- No significant difference in outcomes was observed between patients with small (<50ml) versus medium (50-70ml) core infarct volumes.
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.
- Patients with a target mismatch profile on perfusion imaging should undergo thrombectomy regardless of ASPECTS or core infarction volume in late time windows.
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.
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