Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy

Wenjun Liang; Angela T H Kwan; Huifang Ye; Mohammad Mofatteh; Mingzhu Feng; Jack Wellington; Pingzhong Fu; Wenlong Wei; Yu Sun; Jianhui Huang; Jie Luo; Yimin Chen; Shuiquan Yang; Sijie Zhou

doi:10.2147/RMHP.S436661

Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy

Risk Manag Healthc Policy. 2023 Dec 16:16:2757-2769. doi: 10.2147/RMHP.S436661. eCollection 2023.

Authors

Wenjun Liang¹, Angela T H Kwan², Huifang Ye³, Mohammad Mofatteh⁴, Mingzhu Feng¹, Jack Wellington⁵, Pingzhong Fu⁶, Wenlong Wei¹, Yu Sun¹, Jianhui Huang⁷, Jie Luo⁷, Yimin Chen¹, Shuiquan Yang¹, Sijie Zhou⁷

Affiliations

¹ Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.
² Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Pharmacy, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.
⁴ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
⁵ School of Medicine, Cardiff University, Cardiff, United Kingdom.
⁶ Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, People's Republic of China.
⁷ Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong Province, People's Republic of China.

Abstract

Purpose: In this study, we aimed to determine whether post-Alberta Stroke Project Early CT Changes Score (post-ASPECTS) in anterior stroke and post-(posterior circulation) PC-ASPECTS in posterior stroke on CT can predict post-endovascular thrombectomy (EVT) functional outcomes among patients with acute ischemic stroke (AIS) after EVT.

Patients and methods: A total of 247 consecutive patients aged 18 and over receiving EVT for LVO-related AIS were recruited into a prospective database. The data was retrospectively analyzed between March 2019 and February 2022 from two comprehensive tertiary care stroke centers: Foshan Sanshui District People's Hospital and First People's Hospital of Foshan in China. Patient parameters included EVT within 24 hr of symptom onset, premorbid modified Rankin scale (mRS) ≤2, presence of distal and terminal cerebral blood vessel occlusion, and subsequent 24-72-hr post-stroke onset CT scan. Univariate comparisons were performed using the Fisher's exact test or χ² test for categorical variables and the Mann-Whitney U-test for continuous variables. Logistic regression analysis was performed to further analyze for adjusting for confounding factors. A p-value of ≤0.05 was statistically significant.

Results: Overall, 236 individuals with 196 anterior circulation ischemic strokes and 40 posterior strokes of basilar artery occlusion were examined. Post-ASPECTS in anterior stroke and post-pc-ASPECTS as strong positive markers of favorable outcome at 90 days post-EVT; and lower rates of inpatient mortality/hospice discharge, 90-day mortality, and 90-day poor outcome were observed. Moreover, patients in the post-ASPECTS ≥ 7 cohort experienced shorter door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), and last known normal-to-puncture time (LKNPT).

Conclusion: Post-ASPECTS ≥7 in anterior circulation AIS and post-pc-ASPECTS ≥7 in posterior circulation can serve as strong prognostic markers of functional outcome after EVT.

Keywords: ASPECTS; cerebral ischemic stroke; endovascular therapy; large vessel occlusion; thrombectomy.

Grants and funding

The study was supported by the Foshan Science and Technology Bureau (Grant No. 2220001005022) (Grant No.2220001005354), the Medical Science and Technology Research Foundation of Guangdong Province (Grant No. 20221027164016611), the Foshan 14th Five-Year Plan Key Discipline Foundation, China, the Guangdong provincial TCM Bureau Key Discipline Foundation, China.