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

Jonathan Poggi1,2, Pedro N Martins1,2, Mohamed A Tarek1,2

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The areas of contrast staining for the Alberta Stroke Program Early CT Score (s-ASPECTS) reliably predict functional outcomes after mechanical thrombectomy, outperforming the baseline ASPECTS. This tool enhances stroke outcome prediction.

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blood-brain barriercarotid artery, internalmiddle cerebral arterystrokethrombectomy

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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.