Computed Tomography Perfusion (CTP) and The Alberta stroke program early CT score (ASPECTS) as predictors of favorable outcomes in acute ischemic stroke patients following mechanical thrombectomy

https://doi.org/10.52322/jocmbmh.11.en.05

ABSTRACT

Objectives: This study evaluates the prognostic value of ASPECTS score recovery compared to perfusion imaging in acute anterior circulation cerebral infarction patients undergoing thrombectomy.

Materials and Methods: We conducted a combined retrospective and prospective study involving 87 patients with symptom onset within 6-24 hours who underwent non-contrast CT scans, CTA, CTP, and mechanical thrombectomy at Bach Mai Hospital from January 2022 to May 2023. Stroke outcomes were categorized as good (0-2 points) or poor (3-6 points) based on the modified Rankin functional recovery score (mRS) at 3 months. ROC curves were used to compare the prognostic value of ASPECTS, infarct core, penumbra, and mismatch ratio for predicting stroke outcomes.

Results: The study included 87 patients. At 90 days, 54% of patients achieved good mRS function (0-2), while 46% had poor mRS function (3-6). ROC curves revealed that, among the ASPECTS, infarct core, penumbral tissue, and mismatch ratio indices, only ASPECTS exhibited strong predictive ability for stroke outcomes (p <0.001), with an area under the curve of 0.727. The cutoff value for ASPECTS was determined to be 6, with a sensitivity of 74.7% and specificity of 57.5%.

Conclusion: ASPECTS demonstrates robust predictive capabilities for favorable functional recovery in AIS patients undergoing thrombectomy within an extended time window. This suggests that ASPECTS ≥ 6 may serve as an alternative to CTP in selecting patients for mechanical thrombectomy in facilities lacking advanced imaging capabilities.

Keywords: stroke after 6 hours, thrombectomy, ASPECTS, CT perfusion.

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