Topographic Assessment of Acute Ischemic Changes for Prognostication of Anterior Circulation Stroke.
The location of acute ischemic infarct can affect the clinical outcome of stroke patients. We aimed to develop a prognostic tool based on the topographic distribution of early ischemic changes on admission computed tomography (CT) scans.



Using the albumin in acute stroke (ALIAS) trials dataset, patients with anterior circulation stroke were included for analysis. A 3-month modified Rankin scale (mRs) score > 2 defined disability/death; and ≤2 defined favorable outcome. A penalized logistic regression determined independent predictors of disability/death among components of admission CT scan Alberta Stroke Program Early CT score (ASPECTS). Follow-up 24-hour CT/MRI scans were reviewed for intracranial hemorrhage (ICH).



A simplified ASPECTS (sASPECTS) was developed including the caudate, lentiform nucleus, insula, and M5 components of ASPECTS-which were independent predictors of disability/death on multivariate analysis. There was no significant difference between ASPECTS and sASPECTS in prediction of disability/death (P = .738). Among patients with sASPECTS ≥ 1, the rate of favorable outcome was higher in those with intravenous (IV) thrombolytic therapy (501/837, 59.9%) versus those without treatment (91/183, 49.7%, P = .013); whereas among patients with sASPECTS of 0, IV thrombolysis was not associated with improved outcome. Also, patients with sASPECTS of 0 were more likely to develop symptomatic ICH (odds ratio = 2.62, 95% confidence interval: 1.49-4.62), compared to those with sASPECTS ≥ 1 (P = .004).



Topographic assessment of acute ischemic changes using the sASPECTS (including caudate, lentiform nucleus, insula, and M5) can predict disability/death in anterior circulation stroke as accurately as the ASPECTS; and may help predict response to treatment and risk of developing symptomatic ICH.
Zeenat Qureshi Stroke Institute, St. Cloud, MN.|Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
Seyedmehdi
S
Payabvash
Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN.
Siamak
S
Noorbaloochi
Zeenat Qureshi Stroke Institute, St. Cloud, MN.
Adnan I
AI
Qureshi
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
Ischemic stroke; clinical outcome; thrombolytic therapy; topology