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Imaging mismatch between Alberta Stroke Program Early CT Score and perfusion imaging may be a good variable for endovascular treatment

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

Some patients with acute large vessel occlusion (LVO) presented imaging mismatch, low Alberta Stroke Program Early CT Score (ASPECTS) with small ischemic core, or high ASPECTS with large ischemic core. The study was designed to explore whether patients with imaging mismatch could benefit from endovascular treatment (EVT).

Methods

We retrospectively reviewed patients with LVO treated with EVT in our center from March 2018 to Jul 2020. Patients were divided into three groups, imaging mismatch, small ischemic core, and large ischemic core groups. Pooled analyses based on stroke onset to treatment time were done. Multivariate regression analysis was performed to explore the factors for good outcomes.

Results

Sixty-eight of 419 patients with LVO presented with imaging mismatch, and 35 of those (51%) achieved good outcomes after EVT at 90-day. No significant differences were noted in good outcomes and symptomatic intracranial hemorrhage (sICH) between patients with imaging mismatch and small ischemic core. Compared with large ischemic core, patients with imaging mismatch presented lower risk of sICH (95% confidence interval (CI) 0.04–0.75, p = 0.011) within 6 h and higher proportion of good outcomes (95% CI 0.37–0.82, p = 0.002) at 6 to 24 h. Baseline NIHSS (odds ratio (OR) = 0.91, 95% CI 0.88–0.95)), ASPECTS (OR = 1.14, 95% CI 1.01–1.29), ischemic core (OR = 0.99, 95% CI 0.98–1.00), and sICH (OR = 61.61, 95% CI 8.09–461.32) were associated with good outcomes.

Conclusions

Patients with imaging mismatch treated within 24 h could benefit from EVT and without increasing the risk of sICH.

Key Points

• Patients with imaging mismatch between ASPECTS and ischemic core could achieve good outcomes after endovascular treatment.

• Compared with large ischemic core, patients with imaging mismatch presented lower risk of symptomatic hemorrhage within 6 h and higher proportion of good outcomes within 6–24 h.

• Baseline NIHSS score, ASPECTS, ischemic core, and symptomatic intracranial hemorrhage were associated with good outcomes.

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Abbreviations

ASITN/SIRs:

American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale

ASPECTS:

Alberta Stroke Program Early CT Score

CBF:

Relative cerebral blood flow

CI:

Confidence interval

CT:

Computed tomography

EVT:

Endovascular treatment

HALC:

High ASPECTS with large ischemic core

ICH:

Intracranial hemorrhage

IQR:

Inter-quartile range

LASC:

Low ASPECTS with small ischemic core

LVO:

Large vessel occlusions

mRS:

Modified Rankin Scale

mTICI:

Modified thrombolysis in cerebral infarction scale

NIHSS:

National Institutes of Health Stroke Scale

OR:

Odds ratio

RAPID:

Automated computed tomography analysis software

sICH:

Symptomatic intracranial hemorrhage

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Acknowledgements

We thank all nurses of the Department of Neurovascular Center for their care on the patients.

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Author notes

  1. Pengfei Xing, Xiaowen Zhou and Fang Shen contributed equally to this work.

Authors and Affiliations

  1. Department of Neurovascular Center, Changhai Hospital, Naval Medical University, No.168 Changhai Rd, Shanghai, 200433, China

    Pengfei Xing, Fang Shen, Yu Zhou, Hongjian Shen, Lei Zhang, Pengfei Yang, Yongwei Zhang & Jianmin Liu

  2. Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, China

    Xiaowen Zhou

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  1. Pengfei Xing
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Correspondence to Yongwei Zhang.

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The scientific guarantor of this publication is Yongwei Zhang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

• observational

• monocentric study

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Xing, P., Zhou, X., Shen, F. et al. Imaging mismatch between Alberta Stroke Program Early CT Score and perfusion imaging may be a good variable for endovascular treatment. Eur Radiol 33, 2629–2637 (2023). https://doi.org/10.1007/s00330-022-09273-6

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  • DOI: https://doi.org/10.1007/s00330-022-09273-6

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