Post-Thrombectomy Flat-Panel CT Contrast Staining ASPECTS and Functional Outcome Prediction.

Area of Science:

• Neurology
• Radiology
• Interventional Neurology

Background:

• Mechanical thrombectomy utilization is expanding, necessitating improved functional outcome prediction tools.
• The Alberta Stroke Program Early CT Score (ASPECTS) is a standard imaging biomarker.
• Contrast staining (s-ASPECTS) on immediate post-thrombectomy imaging may offer prognostic value.

Purpose of the Study:

• To evaluate the reliability of s-ASPECTS from immediate post-thrombectomy flat-panel CT.
• To investigate the outcome predictive performance of s-ASPECTS.
• To assess the added value of s-ASPECTS to existing prediction models like MR-PREDICTS.

Main Methods:

• Retrospective analysis of a prospectively collected mechanical thrombectomy database (March 2018-February 2024).
• Calculation of s-ASPECTS on immediate post-thrombectomy flat-panel CT.
• Ordinal logistic regression to correlate s-ASPECTS with 90-day modified Rankin Scale and assess added value to MR-PREDICTS.

Main Results:

• s-ASPECTS was independently associated with functional outcomes in 1063 patients.
• s-ASPECTS outperformed baseline ASPECTS and correlated with occlusion site and reperfusion.
• Flat-panel CT-derived s-ASPECTS added 18% new information to the MR-PREDICTS tool (κ=0.63).

Conclusions:

• s-ASPECTS is a reliable and stronger predictor of functional outcome post-mechanical thrombectomy than baseline ASPECTS.
• s-ASPECTS serves as a valuable prognostic tool for post-stroke intervention.
• Further research is recommended to validate these findings.