Early computed tomography-based scores to predict decompressive hemicraniectomy after endovascular therapy in acute ischemic stroke

Ilko L Maier; Daniel Behme; Marlena Schnieder; Ioannis Tsogkas; Katharina Schregel; Mathias Bähr; Michael Knauth; Jan Liman; Marios-Nikos Psychogios

doi:10.1371/journal.pone.0173737

Early computed tomography-based scores to predict decompressive hemicraniectomy after endovascular therapy in acute ischemic stroke

PLoS One. 2017 Mar 10;12(3):e0173737. doi: 10.1371/journal.pone.0173737. eCollection 2017.

Authors

Ilko L Maier¹, Daniel Behme², Marlena Schnieder¹, Ioannis Tsogkas², Katharina Schregel², Mathias Bähr¹, Michael Knauth², Jan Liman¹, Marios-Nikos Psychogios²

Affiliations

¹ Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.
² Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.

Abstract

Background: Identification of patients requiring decompressive hemicraniectomy (DH) after endovascular therapy (EVT) is crucial as clinical signs are not reliable and early DH has been shown to improve clinical outcome. The aim of our study was to identify imaging-based scores to predict the risk for space occupying ischemic stroke and DH.

Methods: Prospectively derived data from patients with acute large artery occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Predictive value of non-contrast cranial computed tomography (ncCT) and cerebral blood volume (CBV) Alberta Stroke Program Early CT score (ASPECTS) were investigated for DH using logistic regression models and Receiver Operating Characteristic Curve analysis.

Results: From 218 patients with EVT, DH was performed in 20 patients (9.2%). Baseline- (7 vs. 9; p = 0.009) and follow-up ncCT ASPECTS (1 vs. 7, p<0.001) as well as baseline CBV ASPECTS (5 vs. 7, p<0.001) were significantly lower in patients with DH. ncCT (baseline: OR 0.71, p = 0.018; follow-up: OR 0.32, p = <0.001) and CBV ASPECTS (OR 0.63, p = 0.008) predicted DH. Cut-off ncCT-ASPECTS on baseline was 7-, ncCT-ASPECTS on follow-up was 4- and CBV ASPECTS on baseline was 5 points.

Conclusions: ASPECTS could be useful to early identify patients requiring DH after EVT for acute large vessel occlusion.

MeSH terms

Aged
Brain Ischemia / diagnostic imaging
Brain Ischemia / surgery
Cerebral Blood Volume
Decompressive Craniectomy*
Endovascular Procedures / methods*
Female
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
ROC Curve
Stroke / diagnostic imaging*
Stroke / surgery*
Tomography, X-Ray Computed / methods*

Grants and funding

The authors acknowledge support by the German Research Foundation and the Open Access Publication Funds of the Göttingen University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.