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Serial ASPECTS in the DAWN Trial: Infarct Evolution and Clinical Impact
David S Liebeskind1, Hamidreza Saber1, Parita Bhuva2
1Neurovascular Imaging Research Core, UCLA, Los Angeles, CA (D.S.L., H.S.).
Stroke
|July 20, 2021
Summary
In late stroke thrombectomy, baseline Alberta Stroke Program Early CT Score (ASPECTS) and its 24-hour evolution are influenced by factors like age and glucose. Higher 24-hour ASPECTS, particularly after endovascular treatment, predicts better clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- The Alberta Stroke Program Early CT Score (ASPECTS) is crucial for assessing ischemic stroke severity.
- Understanding how baseline ischemia and its evolution impact ASPECTS in late thrombectomy is vital for treatment decisions.
- The DAWN trial provides a unique dataset to analyze these factors in patients undergoing neurointervention.
Purpose of the Study:
- To analyze predictors of serial ASPECTS and clinical outcomes in patients from the DAWN trial.
- To investigate the impact of baseline ischemia and 24-hour infarct evolution on ASPECTS in late thrombectomy.
- To determine the relationship between ASPECTS, treatment, and clinical outcomes in acute ischemic stroke.
Main Methods:
- ASPECTS were independently scored at baseline and 24 hours by the DAWN Imaging Core Laboratory.
- Descriptive statistics characterized ASPECTS changes over 24 hours using computed tomography/magnetic resonance imaging.
- Multivariable logistic regression identified predictors of baseline and 24-hour ASPECTS, and clinical outcomes.
Main Results:
- Older age and dyslipidemia were associated with higher baseline ASPECTS.
- Endovascular treatment, lower baseline NIHSS, and controlled glucose (<150 mg/dL) predicted higher 24-hour ASPECTS.
- Higher 24-hour ASPECTS was a significant predictor of good clinical outcome (90-day mRS 0-2).
- Elevated baseline glucose and internal carotid artery occlusion predicted significant infarct evolution (ASPECTS decrease ≥4).
- ASPECTS change was significantly influenced by treatment arm, with more patients in the endovascular arm showing no ASPECTS change.
Conclusions:
- Patients in the DAWN trial with small infarct cores exhibited a wide range of baseline ASPECTS.
- Twenty-four-hour ASPECTS, significantly influenced by endovascular therapy, effectively predicted good clinical outcomes.
- Baseline glucose levels and lesion location are important factors in stroke evolution and ASPECTS changes.
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