Skip to main content

Advertisement

SpringerLink
Log in

Post-stroke ASPECTS predicts outcome after thrombectomy

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Infarct growth and final infarct volume are established outcome modifiers following endovascular thrombectomy (EVT) for patients with large vessel occlusion stroke (LVO). Simple techniques for final infarct volume measurement are lacking, and therefore, we tested whether post-EVT ASPECTS can be used for prognostic evaluation after EVT.

Methods

Infarct size at baseline was measured in a prospective cohort of patients with LVO that underwent EVT with the ASPECTS score on admission non-contrast CT. Final infarct size was assessed with a post-EVT ASPECTS (ASPECTS-POST) obtained from a follow-up CT 24–72 h post-EVT. The best performing ASPECTS-POST was chosen based on comparisons of different thresholds. Outcome measures included survival rates and modified Rankin Score at 90 days.

Results

A total of 272 patients were included and 166 of them had an ASPECTS-POST ≥ 7. ASPECTS-POST ≥ 7 was associated with increased likelihood of favorable outcome at 90 days (67% vs. 21%, p < 0.001) with sensitivity, specificity, and positive and negative predictive values of 86%, 58%, 61%, and 85%, respectively. On multivariate analysis, ASPECTS-POST ≥ 7 was found to be a significant modifier of favorable outcome (Odds Ratio [OR] 6.2, 95% confidence intervals [CI] 3.1–12.4) and survival (OR 5.8 95% CI 2.4–14.3).

Conclusion

ASPECTS can be rapidly and easily obtained from the post-EVT NCCT and ASPECTS-POST ≥ 7 correlates with good outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millan M, Davis SM, Roy D, Thornton J, Roman LS, Ribo M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG, collaborators H (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 387:1723–1731. https://doi.org/10.1016/S0140-6736(16)00163-X

    Article  PubMed  Google Scholar 

  2. Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Yavagal DR, Saver JL (2015) Relationships between imaging assessments and outcomes in solitaire with the intention for thrombectomy as primary endovascular treatment for acute ischemic stroke. Stroke 46(10):2786–2794. https://doi.org/10.1161/STROKEAHA.115.010710

    Article  CAS  PubMed  Google Scholar 

  3. Man S, Aoki J, Hussain MS, Wisco D, Tateishi Y, Toth G, Hui FK, Uchino K (2015) Predictors of infarct growth after endovascular therapy for acute ischemic stroke. J Stroke Cerebrovasc Dis 24(2):401–407. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.004

    Article  PubMed  Google Scholar 

  4. Marks MP, Lansberg MG, Mlynash M, Kemp S, McTaggart R, Zaharchuk G, Bammer R, Albers GW, Investigators D (2014) Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome. J Neurointerv Surg 6(10):724–728. https://doi.org/10.1136/neurintsurg-2013-010973

    Article  PubMed  Google Scholar 

  5. Al-Ajlan FS, Al Sultan AS, Minhas P, Assis Z, de Miquel MA, Millan M, San Roman L, Tomassello A, Demchuk AM, Jovin TG, Cuadras P, Davalos A, Goyal M, Menon BK, Investigators R (2018) Posttreatment infarct volumes when compared with 24-hour and 90-day clinical outcomes: insights from the REVASCAT randomized controlled trial. AJNR Am J Neuroradiol 39(1):107–110. https://doi.org/10.3174/ajnr.A5463

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Al-Ajlan FS, Goyal M, Demchuk AM, Minhas P, Sabiq F, Assis Z, Willinsky R, Montanera WJ, Rempel JL, Shuaib A, Thornton J, Williams D, Roy D, Poppe AY, Jovin TG, Sapkota BL, Baxter BW, Krings T, Silver FL, Frei DF, Fanale C, Tampieri D, Teitelbaum J, Lum C, Dowlatshahi D, Shankar JJ, Barber PA, Hill MD, Menon BK, Investigators ET (2016) Intra-arterial therapy and post-treatment infarct volumes: insights from the ESCAPE randomized controlled trial. Stroke 47(3):777–781. https://doi.org/10.1161/STROKEAHA.115.012424

    Article  CAS  PubMed  Google Scholar 

  7. Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, de Rochemont RM, Singer OC, Bammer R, Saver JL (2016) Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol 79(1):76–89. https://doi.org/10.1002/ana.24543

    Article  PubMed  Google Scholar 

  8. Boers AMM, Jansen IGH, Brown S, Lingsma HF, Beenen LFM, Devlin TG, Roman LS, Heo JH, Ribo M, Almekhlafi MA, Liebeskind DS, Teitelbaum J, Cuadras P, du Mesnil de Rochemont R, Beaumont M, Brown MM, Yoo AJ, Donnan GA, Mas JL, Oppenheim C, Dowling RJ, Moulin T, Agrinier N, Lopes DK, Aja Rodriguez L, Compagne KCJ, Al-Ajlan FS, Madigan J, Albers GW, Soize S, Blasco J, Davis SM, Nogueira RG, Davalos A, Menon BK, van der Lugt A, Muir KW, Roos Y, White P, Mitchell PJ, Demchuk AM, van Zwam WH, Jovin TG, van Oostenbrugge RJ, Dippel DWJ, Campbell BCV, Guillemin F, Bracard S, Hill MD, Goyal M, Marquering HA, Majoie C (2019) Mediation of the relationship between endovascular therapy and functional outcome by follow-up infarct volume in patients with acute ischemic stroke. JAMA Neurol 76(2):194–202. https://doi.org/10.1001/jamaneurol.2018.3661

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zaidi SF, Aghaebrahim A, Urra X, Jumaa MA, Jankowitz B, Hammer M, Nogueira R, Horowitz M, Reddy V, Jovin TG (2012) Final infarct volume is a stronger predictor of outcome than recanalization in patients with proximal middle cerebral artery occlusion treated with endovascular therapy. Stroke 43(12):3238–3244. https://doi.org/10.1161/STROKEAHA.112.671594

    Article  PubMed  Google Scholar 

  10. Boers AM, Marquering HA, Jochem JJ, Besselink NJ, Berkhemer OA, van der Lugt A, Beenen LF, Majoie CB, Investigators MC (2013) Automated cerebral infarct volume measurement in follow-up noncontrast CT scans of patients with acute ischemic stroke. AJNR Am J Neuroradiol 34(8):1522–1527. https://doi.org/10.3174/ajnr.A3463

    Article  CAS  PubMed  Google Scholar 

  11. Krongold M, Almekhlafi MA, Demchuk AM, Coutts SB, Frayne R, Eilaghi A (2015) Final infarct volume estimation on 1-week follow-up MR imaging is feasible and is dependent on recanalization status. Neuroimage Clin 7:1–6. https://doi.org/10.1016/j.nicl.2014.10.010

    Article  PubMed  Google Scholar 

  12. Yoo AJ, Chaudhry ZA, Nogueira RG, Lev MH, Schaefer PW, Schwamm LH, Hirsch JA, Gonzalez RG (2012) Infarct volume is a pivotal biomarker after intra-arterial stroke therapy. Stroke 43(5):1323–1330. https://doi.org/10.1161/STROKEAHA.111.639401

    Article  CAS  PubMed  Google Scholar 

  13. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 355(9216):1670–1674

    Article  CAS  Google Scholar 

  14. Bhuva P, Yoo AJ, Jadhav AP, Jovin TG, Haussen DC, Bonafe A, Budzik RJ, Yavagal DR, Hanel RA, Hassan AE, Ribo M, Cognard C, Sila CA, Morgan PM, Zhang Y, Shields R, Smith W, Saver JL, Liebeskind DS, Nogueira RG, Investigators DT (2019) Noncontrast computed tomography Alberta Stroke Program Early CT Score may modify intra-arterial treatment effect in DAWN. Stroke:STROKEAHA118024583. https://doi.org/10.1161/STROKEAHA.118.024583

  15. Broocks G, Rajput F, Hanning U, Faizy TD, Leischner H, Schon G, Gellissen S, Sporns P, Deb-Chatterji M, Thomalla G, Kemmling A, Fiehler J, Flottmann F (2018) Highest lesion growth rates in patients with hyperacute stroke. Stroke:STROKEAHA118023457. https://doi.org/10.1161/STROKEAHA.118.023457

  16. Hill MD, Demchuk AM, Goyal M, Jovin TG, Foster LD, Tomsick TA, von Kummer R, Yeatts SD, Palesch YY, Broderick JP, Investigators IMS (2014) Alberta Stroke Program early computed tomography score to select patients for endovascular treatment: Interventional Management of Stroke (IMS)-III Trial. Stroke 45(2):444–449. https://doi.org/10.1161/STROKEAHA.113.003580

    Article  PubMed  Google Scholar 

  17. Park JS, Lee JM, Kwak HS, Chung GH (2019) Predictive value of CT angiography source image ASPECTS in patients with anterior circulation acute ischemic stroke after endovascular treatment: ultimate infarct size and clinical outcome. J Neurointerv Surg 11(4):342–346. https://doi.org/10.1136/neurintsurg-2018-014359

    Article  PubMed  Google Scholar 

  18. Yoo AJ, Berkhemer OA, Fransen PS, van den Berg LA, Beumer D, Lingsma HF, Schonewille WJ, Sprengers ME, van den Berg R, van Walderveen MA, Beenen LF, Wermer MJ, Nijeholt GJ, Boiten J, Jenniskens SF, Bot JC, Boers AM, Marquering HA, Roos YB, van Oostenbrugge RJ, Dippel DW, van der Lugt A, van Zwam WH, Majoie CB, Investigators MC (2016) Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN). Lancet Neurol 15(7):685–694. https://doi.org/10.1016/S1474-4422(16)00124-1

    Article  PubMed  Google Scholar 

  19. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20(7):864–870

    Article  CAS  Google Scholar 

  20. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41

    Article  Google Scholar 

  21. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34(8):e109–e137

    Article  Google Scholar 

  22. Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2(5):200–215. https://doi.org/10.1177/003693305700200504

    Article  CAS  PubMed  Google Scholar 

  23. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators E (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329. https://doi.org/10.1056/NEJMoa0804656

    Article  CAS  PubMed  Google Scholar 

  24. Broocks G, Kniep H, Schramm P, Hanning U, Flottmann F, Faizy T, Schonfeld M, Meyer L, Schon G, Aulmann L, Machner B, Royl G, Fiehler J, Kemmling A (2019) Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization. J Neurointerv Surg 12:747–752. https://doi.org/10.1136/neurintsurg-2019-015308

    Article  PubMed  Google Scholar 

  25. Baird AE, Lovblad KO, Dashe JF, Connor A, Burzynski C, Schlaug G, Straroselskaya I, Edelman RR, Warach S (2000) Clinical correlations of diffusion and perfusion lesion volumes in acute ischemic stroke. Cerebrovasc Dis 10(6):441–448. https://doi.org/10.1159/000016105

    Article  CAS  PubMed  Google Scholar 

  26. Lovblad KO, Baird AE, Schlaug G, Benfield A, Siewert B, Voetsch B, Connor A, Burzynski C, Edelman RR, Warach S (1997) Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol 42(2):164–170. https://doi.org/10.1002/ana.410420206

    Article  CAS  PubMed  Google Scholar 

  27. Albers GW, Wald MJ, Mlynash M, Endres J, Bammer R, Straka M, Maier A, Hinson HE, Sheth KN, Taylor Kimberly W, Molyneaux BJ (2019) Automated calculation of Alberta Stroke Program Early CT Score: validation in patients with large hemispheric infarct. Stroke 50(11):3277–3279. https://doi.org/10.1161/STROKEAHA.119.026430

    Article  PubMed  Google Scholar 

  28. Reznik ME, Yaghi S, Jayaraman MV, McTaggart RA, Hemendinger M, Mac Grory BC, Burton TM, Cutting SM, Siket MS, Madsen TE, Thompson BB, Wendell LC, Mahta A, Potter NS, Furie KL (2018) Baseline NIH Stroke Scale is an inferior predictor of functional outcome in the era of acute stroke intervention. Int J Stroke 13(8):806–810. https://doi.org/10.1177/1747493018783759

    Article  PubMed  Google Scholar 

  29. King S, Khatri P, Carrozella J, Spilker J, Broderick J, Hill M, Tomsick T (2007) Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials. AJNR Am J Neuroradiol 28(10):1890–1894. https://doi.org/10.3174/ajnr.A0702

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was supported in part by the Peritz and Chantal Scheinberg Cerebrovascular Research Fund.

Author information

Authors and Affiliations

  1. Department of Neurology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel

    Ronen R. Leker, Asaf Honig, Andrei Filioglo & Naaem Simaan

  2. Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    John M. Gomori

  3. Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Jose E. Cohen

Authors
  1. Ronen R. Leker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Asaf Honig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrei Filioglo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naaem Simaan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John M. Gomori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jose E. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronen R. Leker.

Ethics declarations

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not obtained from all individual participants included in the study because the IRB approved a retrospective analysis of anonymized data without the need to obtain informed consent.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leker, R.R., Honig, A., Filioglo, A. et al. Post-stroke ASPECTS predicts outcome after thrombectomy. Neuroradiology 63, 769–775 (2021). https://doi.org/10.1007/s00234-020-02576-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-020-02576-9

Keywords

Search

Navigation