Kim-Tenser May, Mlynash Michael, Lansberg Maarten G, Tenser Matthew, Bulic Sebina, Jagadeesan Bharathi, Christensen Soren, Simpkins Alexis, Albers Gregory W, Marks Michael P, Heit Jeremy J
Department of Neurology, 5116University of Southern California, Los Angeles, CA, USA.
Department of Neurology, Stanford University, Palo Alto, CA, USA.
Int J Stroke. 2021 Apr;16(3):288-294. doi: 10.1177/1747493020915141. Epub 2020 Mar 31.
The role of Alberta Stroke Program Early CT Score (ASPECTS) for thrombectomy patient selection and prognostication in late time windows is unknown.
We compared baseline ASPECTS and core infarction determined by CT perfusion (CTP) as predictors of clinical outcome in the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE) 3 trial.
We included all DEFUSE 3 patients with baseline non-contrast CT and CTP imaging. ASPECTS and core infarction were determined by the DEFUSE 3 core laboratory. Primary outcome was functional independence (modified Rankin Scale (mRS) ≤2). Secondary outcomes included ordinal mRS shift at 90 days and final core infarction volume.
Of the 142 patients, 85 patients (60%) had ASPECTS 8-10 and 57 (40%) had ASPECTS 5-7. Thirty-one patients (36%) with ASPECTS 8-10 and 11 patients (19%) with ASPECTS 5-7 were functionally independent at 90 days ( = 0.03). In the primary and secondary logistic regression analysis, there was no difference in ordinal mRS shift ( = 0.98) or functional independence (mRS ≤ 2; = 0.36) at 90 days between ASPECTS 8-10 and ASPECTS 5-7 patients. Similarly, primary and secondary logistic regression analyses found no difference in ordinal mRS shift ( = 1.0) or functional independence (mRS ≤ 2; = 0.87) at 90 days between patients with baseline small core ( < 50 ml) versus medium core (50-70 ml).
Higher ASPECTS (8-10) correlated with functional independence at 90 days in the DEFUSE trial. ASPECTS and core infarction volume did not modify the thrombectomy treatment effect, which indicates that patients with a target mismatch profile on perfusion imaging should undergo thrombectomy regardless of ASPECTS or core infarction volume in late time windows.
阿尔伯塔卒中项目早期CT评分（ASPECTS）在晚期时间窗内对血栓切除术患者选择及预后判断中的作用尚不清楚。
在缺血性卒中影像评估后血管内治疗3（DEFUSE）3试验中，我们比较了基线ASPECTS和CT灌注（CTP）确定的核心梗死灶，作为临床结局的预测指标。
我们纳入了所有有基线非增强CT和CTP影像的DEFUSE 3患者。ASPECTS和核心梗死灶由DEFUSE 3核心实验室确定。主要结局为功能独立性（改良Rankin量表（mRS）≤2）。次要结局包括90天时mRS的序数变化及最终核心梗死灶体积。
142例患者中，85例（60%）ASPECTS为8 - 10分，57例（40%）ASPECTS为5 - 7分。90天时，31例（36%）ASPECTS为8 - 10分的患者和11例（19%）ASPECTS为5 - 7分的患者功能独立（P = 0.03）。在主次逻辑回归分析中，ASPECTS为8 - 10分的患者和ASPECTS为5 - 7分的患者在90天时mRS的序数变化（P = 0.98）或功能独立性（mRS≤2；P = 0.36）无差异。同样，主次逻辑回归分析发现，基线时核心梗死灶小（＜50 ml）的患者和核心梗死灶中等（50 - 70 ml）的患者在90天时mRS的序数变化（P = 1.0）或功能独立性（mRS≤2；P = 0.87）无差异。
在DEFUSE试验中，较高的ASPECTS（8 - 10）与90天时的功能独立性相关。ASPECTS和核心梗死灶体积并未改变血栓切除术的治疗效果，这表明在晚期时间窗内，灌注成像显示目标不匹配的患者，无论ASPECTS或核心梗死灶体积如何，均应接受血栓切除术。
