title: Early computed tomography-based scores to predict decompressive hemicraniectomy after endovascular therapy in acute ischemic stroke.
abstract: BACKGROUND
  Identification of patients requiring decompressive hemicraniectomy (DH) after endovascular therapy (EVT) is crucial as clinical signs are not reliable and early DH has been shown to improve clinical outcome. The aim of our study was to identify imaging-based scores to predict the risk for space occupying ischemic stroke and DH.
  
  
  METHODS
  Prospectively derived data from patients with acute large artery occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Predictive value of non-contrast cranial computed tomography (ncCT) and cerebral blood volume (CBV) Alberta Stroke Program Early CT score (ASPECTS) were investigated for DH using logistic regression models and Receiver Operating Characteristic Curve analysis.
  
  
  RESULTS
  From 218 patients with EVT, DH was performed in 20 patients (9.2%). Baseline- (7 vs. 9; p = 0.009) and follow-up ncCT ASPECTS (1 vs. 7, p<0.001) as well as baseline CBV ASPECTS (5 vs. 7, p<0.001) were significantly lower in patients with DH. ncCT (baseline: OR 0.71, p = 0.018; follow-up: OR 0.32, p = <0.001) and CBV ASPECTS (OR 0.63, p = 0.008) predicted DH. Cut-off ncCT-ASPECTS on baseline was 7-, ncCT-ASPECTS on follow-up was 4- and CBV ASPECTS on baseline was 5 points.
  
  
  CONCLUSIONS
  ASPECTS could be useful to early identify patients requiring DH after EVT for acute large vessel occlusion.
authors.affiliation: Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Ilko L
authors.identifier: http://orcid.org/0000-0001-6988-8878
authors.initials: IL
authors.lastname: Maier
authors.affiliation: Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Behme
authors.affiliation: Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Marlena
authors.initials: M
authors.lastname: Schnieder
authors.affiliation: Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsogkas
authors.affiliation: Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schregel
authors.affiliation: Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bähr
authors.affiliation: Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.affiliation: Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Liman
authors.affiliation: Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Marios-Nikos
authors.initials: MN
authors.lastname: Psychogios
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D000071937:Cerebral Blood Volume; D056424:Decompressive Craniectomy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*