ASPECTS decay during inter-facility transfer in patients with large vessel occlusion strokes.
BACKGROUND
Favorable imaging profile according to the Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast head CT is a key criterion for the selection of patients with ischemic stroke from large vessel occlusion (LVO) for IA revascularization therapies.


OBJECTIVE
To analyze factors associated with changes in ASPECTS during inter-hospital transfer and to determine how deterioration of ASPECTS affects eligibility for endovascular procedures.


METHODS
We analyzed factors associated with changes in ASPECTS during inter-hospital transfer and their potential impact on eligibility for IA stroke therapies in patients with anterior circulation ischemic strokes. Clinical and demographic characteristics between patients with favorable (ASPECTS ≥6) and unfavorable (ASPECTS <6) imaging on repeat CT were compared.


RESULTS
Stroke evolution towards unfavorable ASPECTS occurred in 13/42 (31%) patients who initially had a favorable imaging profile at outside hospitals. A higher National Institutes of Health Stroke Scale (NIHSS) score was the only significant predictor of ASPECTS decay, whereas other clinical characteristics, such as the use of IV thrombolysis and site of LVO, were similar between the two groups.


CONCLUSIONS
In our cohort, one out of three patients became ineligible for IA thrombectomy because of unfavorable ASPECTS 'decay' following inter-hospital transfer. Except for NIHSS severity, baseline clinical factors could not identify which patients were at risk for ASPECTS deterioration.
Department of Neurology, University of South Florida, Tampa, Florida, USA.
Maxim
M
Mokin
Wellstar Neurosurgery, Marietta, Georgia, USA.
Rishi
R
Gupta
Department of Neurology, University of South Florida, Tampa, Florida, USA.
Waldo R
WR
Guerrero
Department of Neurology, University of South Florida, Tampa, Florida, USA.
David Z
DZ
Rose
Department of Neurology, University of South Florida, Tampa, Florida, USA.
William S
WS
Burgin
Department of Neurology, University of South Florida, Tampa, Florida, USA.
Sananthan
S
Sivakanthan
D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000639:trends*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D017131:Thrombectomy / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000639:trends*
CT; Stroke; Thrombectomy