ASPECTS decay during inter-facility transfer predicts patient outcomes in endovascular reperfusion for ischemic stroke: a unique assessment of dynamic physiologic change over time.
BACKGROUND
Pretreatment Alberta Stroke Program Early CT Scores (ASPECTS) is associated with clinical outcomes. The rate of decline between subsequent images, however, may be more predictive of outcomes as it integrates time and physiology.


METHODS
A cohort of patients transferred from six primary stroke centers and treated with intra-arterial therapy (IAT) was retrospectively studied. Absolute ASPECTS decay was defined as ((ASPECTS First CT-ASPECTS Second CT)/hours elapsed between images). A logistic regression model was performed to determine if the rate of ASPECTS decay predicted good outcomes at 90 days (modified Rankin Scale score of 0-2).


RESULTS
106 patients with a mean age of 66±14 years and a median National Institutes of Health Stroke Scale score of 19 (IQR 15-23) were analyzed. Median time between initial CT at the outside hospital to repeat CT at our facility was 2.7 h (IQR 2.0-3.6). Patients with good outcomes had lower rates of absolute ASPECTS decay compared with those who did not (0.14±0.23 score/h vs 0.49±0.39 score/h; p<0.001). In multivariable modeling, the absolute rate of ASPECTS decay (OR 0.043; 95% CI 0.004 to 0.471; p=0.01) was a stronger predictor of good patient outcome than static pretreatment ASPECTS obtained before IAT (OR 0.64; 95% CI 0.38 to 1.04; p=0.075). In practical terms, every 1 unit increase in ASPECTS decline per hour correlates with a 23-fold lower probability of a good outcome.


CONCLUSIONS
Patients with faster rates of ASPECTS decay during inter-facility transfers are associated with worse clinical outcomes. This value may reflect the rate of physiological infarct expansion and thus serve as a tool in patient selection for IAT.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Chung-Huan J
CH
Sun
Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Kerrin
K
Connelly
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Raul G
RG
Nogueira
Wellstar Health System, Marietta, Georgia, USA.
Brenda A
BA
Glenn
Wellstar Health System, Marietta, Georgia, USA.
Susan
S
Zimmermann
v Southern Regional Medical Center, Riverdale, Georgia, USA.
Kim
K
Anda
Atlanta Medical Center, Atlanta, Georgia, USA.
Deborah
D
Camp
Gwinnett Medical Center, Gwinnett, Georgia, USA.
Susan
S
Gaunt
Gwinnett Medical Center, Gwinnett, Georgia, USA.
Herma
H
Pallard
Northside Hospital, Atlanta, Georgia, USA.
Michele
M
Eckenroth
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Michael R
MR
Frankel
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Samir R
SR
Belagaje
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Aaron M
AM
Anderson
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Fadi
F
Nahab
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Manuel
M
Yepes
Wellstar Health System, Marietta, Georgia, USA.
Rishi
R
Gupta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*
D010959:Tissue Plasminogen Activator
Stroke; Thrombectomy