title: Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke.
abstract: BACKGROUND
  Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization.
  
  
  METHODS
  Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability).
  
  
  RESULTS
  Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %).
  
  
  CONCLUSIONS
  CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies.
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.|Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain.
authors.forename: Michal M
authors.initials: MM
authors.lastname: Kawiorski
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.affiliation: Hospital Universitario Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: García-Pastor
authors.affiliation: Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Calleja
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Borja E
authors.initials: BE
authors.lastname: Sanz-Cuesta
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lourido
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Marín
authors.affiliation: Hospital Universitario Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Díaz-Otero
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain.
authors.forename: Agustina
authors.initials: A
authors.lastname: Vicente
authors.affiliation: Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid, Spain.|Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Sierra-Hidalgo
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Exuperio
authors.initials: E
authors.lastname: Díez-Tejedor
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fandiño
authors.affiliation: Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain. malecinanacases@salud.madrid.org.|Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain. malecinanacases@salud.madrid.org.
authors.forename: María
authors.identifier: http://orcid.org/0000-0002-4302-6580
authors.initials: M
authors.lastname: Alonso de Leciñana
mesh_terms: D002533:Cerebral Angiography / Q000379:methods / Q000706:statistics & numerical data*; D002548:Cerebral Revascularization / Q000379:methods / Q000401:mortality*; D000072226:Computed Tomography Angiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ASPECTS score; CT-angiography; CTA-SI; Ischemic stroke; Reperfusion therapies
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