Borderline Aspect Score Patients with Acute Ischaemic Stroke Due to Large Vessel Occlusion May Find Benefit with Endovascular Thrombectomy

2017-11-22

Logan, Caitriona

Maingard, Julian

Phan, Kevin

Motyer, Ronan

Barras, Christen

Looby, Seamus

Brennan, Paul

O’Hare, Alan

Brooks, Duncan Mark

Chandra, Ronil V

Asadi, Hamed

Kok, Hong Kuan

Thornton, John

ASPECTS

Acute ischaemic Stroke

Collateral circulation

Endovascular thrombectomy

Interventional neuroradiology

Journal Article

10.1016/j.wneu.2017.11.068

OBJECTIVE: Selection of patients with acute ischaemic stroke (AIS) for endovascular thrombectomy (EVT) is complex and time-critical. The benefits of EVT are well established for patients with small core infarcts. The aim of this study was to compare clinical outcomes of EVT in patients with larger established infarcts (ASPECTS ≤6), with a smaller infarct group (ASPECTS 7-10). METHODS: 355 patients with AIS due to large vessel occlusion (LVO) who underwent EVT were included. ASPECTS was assigned to baseline non-contrast CT and collateral perfusion scores to multiphase CT angiography. Baseline stroke severity, collateral grading, and clinical outcome data (complication rate, symptomatic intracranial haemorrhage and 90-day mRS) between patients with borderline (≤6) and high (7-10) ASPECTS were compared. RESULTS: Thirty-four (10%) had borderline ASPECTS. Overall, there was no difference in the rate of good clinical outcome (37% vs 46%, p=0.852), symptomatic intracerebral haemorrhage (9% vs 9%, p=0.984) or mortality (20% vs 22%, p=0.818) between patients with a borderline ASPECTS and high ASPECTS at 90 days. This was on the background of no significant difference in collateral perfusion grade. CONCLUSIONS: This study identifies similar clinical benefit of EVT in acute LVO stroke patients with borderline and high ASPECTS.

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World Neurosurgery 2017; online first: 22 November

World Neurosurgery