From the Stroke Center (S.N., D.S., G.S., P.M.), Neurology Service
Department of Statistical Science (F.R.), University College London, London, UK.
AJNR Am J Neuroradiol. 2021 Mar;42(3):422-428. doi: 10.3174/ajnr.A6959. Epub 2021 Jan 28.
Both ASPECTS and core volume on CTP are used to estimate infarct volume in acute ischemic stroke. To evaluate the potential role of ASPECTS for acute endovascular treatment decisions, we studied the correlation between ASPECTS and CTP core, depending on the timing and the presence of large-vessel occlusion.
We retrospectively reviewed all MCA acute ischemic strokes with standardized reconstructions of CTP maps entered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) registry. Correlation between ASPECTS and CTP core was determined for early (<6 hours) versus late (6-24 hours) times from stroke onset and in the presence versus absence of large-vessel occlusion. We used correlation coefficients and adjusted multiple linear regression models.
We included 1046 patients with a median age of 71.4 years (interquartile range, IQR = 59.8-79.4 years), an NIHSS score of 12 (IQR, 6-18), an ASPECTS of 9 (IQR, 7-10), and a CTP core of 13.6 mL (IQR, 0.6-52.8 mL). The overall correlation between ASPECTS and CTP core was moderate (ρ = -0.49, < .01) but significantly stronger in the late-versus-early window (ρ = -0.56 and ρ = -0.48, respectively; = .05) and in the presence versus absence of large-vessel occlusion (ρ = -0.40 and ρ = -0.20, respectively; < .01). In the regression model, the independent association between ASPECTS and CTP core was confirmed and was twice as strong in late-arriving patients with large-vessel occlusion (β = -0.21 per 10 mL; 95% CI, -0.27 to -0.15; < .01) than in the overall population (β = -0.10; 95% CI, -0.14 to -0.07; < .01).
In a large cohort of patients with acute ischemic stroke, we found a moderate correlation between ASPECTS and CTP core. However, this was stronger in patients with large-vessel occlusion and longer delay from stroke onset. Our results could support the use of ASPECTS as a surrogate marker of CTP core in late-arriving patients with acute ischemic stroke with large-vessel occlusion.
ASPECTS 和 CTP 核心体积均用于估计急性缺血性卒中的梗死体积。为了评估 ASPECTS 在急性血管内治疗决策中的潜在作用，我们研究了 ASPECTS 与 CTP 核心之间的相关性，具体取决于发病时间和大血管闭塞的存在情况。
我们回顾性分析了所有进入急性卒中登记和分析洛桑 (ASTRAL) 登记处的 MCA 急性缺血性卒中患者的 CTP 图谱的标准化重建。我们确定了早期（<6 小时）与晚期（6-24 小时）发病时间以及大血管闭塞存在与否时 ASPECTS 与 CTP 核心之间的相关性。我们使用相关系数和调整后的多元线性回归模型。
我们纳入了 1046 例年龄中位数为 71.4 岁（四分位距，IQR=59.8-79.4 岁）、NIHSS 评分为 12 分（IQR=6-18 分）、ASPECTS 评分为 9 分（IQR=7-10 分）和 CTP 核心为 13.6 毫升（IQR=0.6-52.8 毫升）的患者。ASPECTS 与 CTP 核心之间的总体相关性为中度（ρ=-0.49，<0.01），但在晚期与早期窗口之间明显更强（ρ=-0.56 和 ρ=-0.48，分别；=0.05），以及在大血管闭塞存在与否之间更强（ρ=-0.40 和 ρ=-0.20，分别；<0.01）。在回归模型中，ASPECTS 与 CTP 核心之间的独立关联得到了确认，并且在大血管闭塞的晚期到达患者中要强两倍（β=每 10 毫升-0.21；95%CI=-0.27 至-0.15；<0.01），而在总体人群中（β=-0.10；95%CI=-0.14 至-0.07；<0.01）。
在一大组急性缺血性卒中患者中，我们发现 ASPECTS 与 CTP 核心之间存在中度相关性。然而，在大血管闭塞和发病时间较长的患者中，这种相关性更强。我们的结果可以支持在大血管闭塞的急性缺血性卒中晚期到达的患者中，将 ASPECTS 用作 CTP 核心的替代标志物。
