Imaging related predictors of favorable outcome in acute ischemic stroke treated by thrombectomy

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Congress:

ECR 2015

Poster Number:

B-0818

Type:

Scientific Paper

Keywords:

CNS, Cardiovascular system, Interventional vascular, CT-Angiography, Image manipulation / Reconstruction, CT, Catheters, Thrombolysis, Recanalisation, Acute, Ischaemia / Infarction, Outcomes

Authors:

A. Balodis, M. Radzina, K. Kupcs, E. Miglane, J. Savlovskis; Riga/LV

DOI:

10.1594/ecr2015/B-0818

DOI-Link:

https://dx.doi.org/10.1594/ecr2015/B-0818

Fig. 1: ASPECTS - Alberta Stroke Program Early CT Score. The level at the basal...

Fig. 2: ASPECTS - Alberta Stroke Program Early CT Score. The level above the basal...

Fig. 3: Thormbus- length was measured on CTA

Fig. 4: ASPECTS - Alberta Stroke Program Early CT Score. ASPECTS core and penumbra...

Purpose

Evaluate the factors that affect the clinical outcome of acute ischemic stroke in patients with endovascular treatment.

Methods and materials

This was retrospective study including 96 patients with middle cerebral artery occlusion. All patients had endovascular thrombectomy as main reperfusion therapy. Collaterals were analysed by two groups (poor vs. good). Thrombus-length was measured on CTA and DSA. Lesion size was evaluated by semiquantitative method on CT perfusion using ASPECTS score. Short-outcome was measured as difference between neurological status evaluated by NIHSS score on admission and at discharge.

Results

In this study, 49 men, 47 women, mean age 70.22±9,36(SD) years. Mean time until thrombectomy was 217.98±74.95(SD) min. Mean thrombus-length was 14 mm, range 5-27 mm. Collaterals were good in 36 patients (38%), and poor in 60 patient (62%) with inter-rater reliability Kappa=0.85 (p=0.001). Lesion size was evaluated on CT perfusion maps using ASPECTS score (mean 7.7±1.8(SD)). Mean NIHSS on admission was 16±4.5(SD), at discharge 6±6.2(SD). There was a positive correlation between longer thrombus and higher NIHSS score at admission (p=0.002) and after thrombectomy (p=0.001)....

Conclusion

Main imaging related predictors for acute stroke short-term outcome were collaterals and lesion size at admission, but time to treatment and thrombus length influenced treatment outcome.

Personal information

Arturs Balodis MD, Radiologist (in training) Diagnostic Radiology Insititute Paula Stradins Clinical University Hospital Riga, Latvia Maija Radzina MD, PhD Radiologist Diagnostic Radiology Insititute Paula Stradins Clinical University Hospital Riga, Latvia Karlis Kupcs MD, PhD Radiologist Head of Diagnostic Radiology Insititute Paula Stradins Clinical University Hospital Riga, Latvia Evija Miglane MD, PhD Neurologist Neurology Department, Head of Stroke unit Paula Stradins Clinical University Hospital Riga, Latvia Janis Savlovskis MD, Radiologist Paula Stradins Clinical University Hospital Riga, Latvia

References

1.Wintermark, 2008; AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke, 2013 2.Radzina M, Savlovskis J, Balodis A, Kupcs K, Miglane E, Millers A. Collateralsand baseline KT perfusion ASPECTS score together are reliable predictors of favorable outcome in acute stroke patients. Cerebrovascular Diseases 2014;37(suppl 1), 9-10. 3 .Riedel CH et al. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 2011 Jun;42(6):1775-7. doi: 10.1161/STROKEAHA.110.609693. Epub 2011 Apr 7. 4. A. Balodis, K. Kupcs,...