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RATE OF ASPECTS DECAY DURING INTERFACILITY TRANSFER AND ITS CORRELATION WITH OUTCOME IN ACUTE ISCHEMIC STROKE
Abstract
Background and Aims
Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is marker of early ischemia in acute ischemic stroke (AIS). Aims of this study were to measure rate of ASPECTS decay & its correlation with radiologic and clinical outcomes.
Methods
Data of patients with AIS were reviewed. AIS patients who underwent two Computed Tomography (CT) head scans within 6 hours of stroke onset included. Posterior circulation strokes excluded. Demographics, last known normal time, National Institute of Health Stroke Score (NIHSS) were noted. CT Head, CT Angiogram (CTA) cerebral angiograms were analyzed. Radiologic outcome included final infarct size. Clinical outcome included NIHSS at discharge. Good outcome was 50% or more improvement in NIHSS and poor outcome was death or < 50% improvement in NIHSS.
Results
107 patients screened. 85 underwent Mechanical Thrombectomy (MT), 46 included in the study. Good outcome in 25 (54.3%) and poor outcome in 21 (45.7%). Groups differed in hypertension (p=0.008) and dyslipidemia (p=0.033). Poor outcome group had greater ASPECTS decay (p=0.046), rate of ASPECTS decay (p=0.049), higher final infarct volume (p=0.000) and lower TICI-3 reperfusion (p=0.003). Final infarct volume was significantly associated with ASPECTS decay (Spearman’s coefficient 0.432, p=0.003) and ASPECTS decay rate (Spearman’s coefficient 0.465, p=0.001). ASPECTS decay Rate >1.6 was associated with poor clinical outcome (p=0.011).
Conclusions
Rapid rate of ASPECTS decay is associated with higher infarct volume and poor clinical outcome in anterior circulation acute ischemic stroke. It may be a tool for prognostication of patients undergoing MT after interfacility transfer.