Abstract TP91: Unfavorable Baseline Hypoperfusion Intensity Ratio is Associated With Infarct Growth and Poor Outcome in Patients With Distal MCA Occlusions

Background: A low hypoperfusion intensity ratio (HIR) predicts good collateral vessel status and correlates with infarct growth and functional outcome in early window patients with proximal large vessel anterior circulation occlusions. Its performance in predicting clinical and radiologic outcome has not been assessed in patients with more distal occlusions. In this retrospective analysis of the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke (CRISP) study, we hypothesized that a favorable baseline HIR would predict less infarct growth in patients with distal middle cerebral artery (MCA) occlusions. Methodology: Patients with occlusions of an M2 or M3 branch of the MCA on catheter angiography were included; all patients underwent mechanical thrombectomy with TICI2B/3 reperfusion. Baseline ischemic core volume and HIR (Tmax >10s / Tmax >6s) were assessed with RAPID software; late follow-up infarct volumes (>36 hours from initial CT perfusion) were manually determined from DWI MRI. Excellent functional outcome was defined as a modified Rankin score of 0-1. Results: Fourteen patients with baseline perfusion and late follow-up imaging were included; nine patients presented with M2 occlusions, and 5 with M3 occlusions. The mean baseline HIR of 0.48 was used to dichotomize patients into favorable or unfavorable baseline profiles. Patients with a favorable baseline HIR had significantly smaller baseline ischemic core volumes (0 mL [IQR 0-3.3] vs. 14.0 mL [IQR 8.7-22.1], p=0.01), smaller final infarct volumes (16.1 mL [IQR 12.7-41.2] vs. 71.4 mL [IQR 43.8-113.5], p=0.01) and less infarct growth (16.1 mL [IQR 9.4-31.9] vs. 49.0 mL [IQR 31.1-100.8], p=0.03). Excellent functional outcome was achieved in 6/6 (100%) of those with favorable baseline HIR, versus 3/8 (37.5%) with unfavorable baseline profile (p=0.03). Conclusion: In patients with distal MCA occlusions, poor collateral status at baseline as demonstrated by a high HIR score is associated with more infarct growth and worse clinical outcomes. HIR may be helpful for guiding thrombectomy decisions in patients with distal occlusions and warrants further prospective study in this population.

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Abstract WMP89: Outcomes No Different in Real World Including Direct vs Drip-and-Ship Patients: Power of Reperfusion From Mechanical Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.wmp89 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Darshan G Shah ◽

Aravi Loganathan ◽

Dan Truong ◽

Fiona Chan ◽

Bruce Campbell ◽

...

Keyword(s):

Functional Outcome ◽

Real World ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Vessel Occlusion ◽

Excellent Functional Outcome ◽

The Mean ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: Mechanical thrombectomy (MT) became standard care in 2015 after positive trials in patients presenting with acute ischemic stroke and large vessel occlusion (LVO) 0-6h and in 2018 for selected patients up to 24h from symptom onset. Objective: To evaluate whether patients receiving MT at our center would have comparable outcomes in patients presenting to our comprehensive stroke center (direct) vs transfer patients (drip-and-ship) Methods: This is a retrospective observational study utilising prospectively collected stroke database for patients receiving MT for LVO in anterior and posterior circulation in South Brisbane network of 7 hospitals (6 drip-and-ship centers and 1 MT-capable center), Australia which serves 1.6 million. Day 90 modified Rankin scale (mRS) was used to assess functional outcomes via outpatient follow up at direct or referral center. The association of drip and ship versus mothership treatment with day 90 mRS was tested in ordinal logistic regression adjusted for age, baseline NIHSS and IV thrombolysis. Results: Of 191 patients who underwent Mechanical Thrombectomy from 2015 to June 2018 at our center, 22 patients were excluded from analysis as either their baseline mRS was >1 (13) or follow up data was missing (9). The mean age was 64.4 years. Median (inter-quartile range, IQR) NIHSS was 16 (9-21) on admission and 7 (2-18) on day 1. Thrombolysis in Cerebral Infarction (TICI) ≥2b was achieved in 88.9%. At 90 days, 50.9% achieved excellent functional outcome (mRS 0-1), 61.4% achieved good functional outcome (mRS 0-2) and 69% achieved favorable outcome (mRS 0-3). Median mRS was 1 (IQR 0-5) in 96 patients presenting directly to the endovascular center and 1 (IQR 1-4) in 73 drip-and-ship patients (common odds ratio 1.07 (95%CI 0.62-1.83), p=0.82) Conclusion: Our 7-center network experience confirms real world reproducibility of trial results, interestingly with no difference in functional outcomes for direct vs drip-and-ship patients.

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Automated CT Perfusion for Ischemic Core Volume Prediction in Tandem Anterior Circulation Occlusions

Interventional Neurology ◽

10.1159/000445763 ◽

2016 ◽

Vol 5 (1-2) ◽

pp. 81-88 ◽

Cited By ~ 2

Author(s):

Diogo C. Haussen ◽

Seena Dehkharghani ◽

Mikayel Grigoryan ◽

Meredith Bowen ◽

Leticia C. Rebello ◽

...

Keyword(s):

Ct Perfusion ◽

Infarct Volume ◽

Volume Estimation ◽

Large Vessel ◽

Absolute Difference ◽

Analysis Tool ◽

Anterior Circulation ◽

Ischemic Core ◽

The Impact ◽

Core Volume

Background/Aim: CT perfusion (CTP) predicts ischemic core volumes in acute ischemic stroke (AIS); however, assumptions made within the pharmacokinetic model may engender errors by the presence of tracer delay or dispersion. We aimed to evaluate the impact of hemodynamic disturbance due to extracranial anterior circulation occlusions upon the accuracy of ischemic core volume estimation with an automated perfusion analysis tool (RAPID) among AIS patients with large-vessel occlusions. Methods: A prospectively collected, interventional database was retrospectively reviewed for all cases of endovascular treatment of AIS between September 2010 and March 2015 for patients with anterior circulation occlusions with baseline CTP and full reperfusion (mTICI3). Results: Out of 685 treated patients, 114 fit the inclusion criteria. Comparison between tandem (n = 21) and nontandem groups (n = 93) revealed similar baseline ischemic core (20 ± 19 vs. 19 ± 25 cm3; p = 0.8), Tmax >6 s (175 ± 109 vs. 162 ± 118 cm3; p = 0.6), Tmax >10 s (90 ± 84 vs. 90 ± 91 cm3; p = 0.9), and final infarct volumes (45 ± 47 vs. 37 ± 45 cm3; p = 0.5). Baseline core volumes were found to correlate with final infarct volumes for the tandem (r = 0.49; p = 0.02) and nontandem (r = 0.44; p < 0.01) groups. The mean absolute difference between estimated core and final infarct volume was similar between patients with and those without (24 ± 41 vs. 17 ± 41 cm3; p = 0.5) tandem lesions. Conclusions: The prediction of baseline ischemic core volumes through an optimized CTP analysis employing rigorous normalization, thresholding, and voxel-wise analysis is not significantly influenced by the presence of underlying extracranial carotid steno-occlusive disease in large-vessel AIS.

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Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

Journal of Neurology ◽

10.1007/s00415-021-10410-2 ◽

2021 ◽

Author(s):

Gabriel Broocks ◽

Hashim Jafarov ◽

Rosalie McDonough ◽

Friederike Austein ◽

Lukas Meyer ◽

...

Keyword(s):

Functional Outcome ◽

Ct Perfusion ◽

Reperfusion Therapy ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Important Mediator ◽

Flow Restoration ◽

Relationship Of ◽

The Relationship

Abstract Background The presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome. Methods 99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging. Results In patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a–2b) reperfusion (median 224 mL, IQR: 168–303 versus 158 mL, IQR: 129–225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17–110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85–0.95, p < 0.0001). Conclusions PSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.

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Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0040-1716848 ◽

2020 ◽

Author(s):

Veenesh Selvaratnam ◽

Andrew Cattell ◽

Keith S. Eyres ◽

Andrew D. Toms ◽

Jonathan R. P. Phillips ◽

...

Keyword(s):

Functional Outcome ◽

Preoperative Planning ◽

Trochlear Dysplasia ◽

Oxford Knee Score ◽

Implant Position ◽

Robotic Assisted ◽

Implant Positioning ◽

Flexion Extension ◽

The Mean

AbstractPatello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

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Abstract 1122‐000142: Safety and Efficacy of Surpass Streamline for Intracranial Aneurysms: A Multicenter US Real‐World Experience (SESSIA)

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000142 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Juan Vivanco‐Suarez ◽

Alan Mendez‐Ruiz ◽

Farooqui Mudassir ◽

Cynthia B Zevallos ◽

Milagros Galecio‐Castillo ◽

...

Keyword(s):

Real World ◽

Intracranial Aneurysms ◽

The United States ◽

Chromium Alloy ◽

Cobalt Chromium ◽

Anterior Circulation ◽

Safety And Efficacy ◽

Post Marketing ◽

The Mean

Introduction : Flow diversion has established itself as standard treatment of wide complex intracranial aneurysms (IA). Its recognition has been validated with positive occlusion rates and favorable clinical outcomes. The Surpass Streamline (SS) flow diverter (FD) is a braided cobalt/chromium alloy implant with 72 or 96 wires approved by the FDA in 2018. The aim of this study is to determine the safety and efficacy of the SS in a post‐marketing large US cohort. Methods : We performed a multicenter, retrospective study for consecutive patients treated with the SS FD for IA between January 2018 and June 2021 in the United States. Inclusion criteria for participants were: 1. Adults (≥ 18 years) and 2. Treatment with SS FD for IA. Primary safety end point was a major ipsilateral stroke (increase in National Institutes of Health Stroke Scale Score of ≥ 4) or neurological death within 12 months. Primary efficacy was assessed using the 3‐point Raymond‐Roy (RR) occlusion scale on digital subtraction angiography (DSA) at 6‐12‐month follow‐up. Results : A total of 276 patients with 313 aneurysms were enrolled. The median age was 59 years and 199 (72%) were females. The most common comorbidities included hypertension in 156 (57%) subjects followed by hyperlipidemia in 76 (28%) patients. One hundred and twenty‐two (44%) patients were asymptomatic while subarachnoid hemorrhage was present in only 10 (4%) patients. A total of 143 (46%) aneurysms were left‐sided. Aneurysms were located as follows: 274 (88%) were in the anterior circulation with paraophthalmic being the most common in 120 (38%) followed by petrocavernous ICA in 81 (26%); 33 (11%) aneurysms were located in the posterior circulation with basilar trunk being the most common in 14 (5%). The mean maximum aneurysm dome width was 5.77 ± 4.7 mm, neck width 4.22 ± 3.8 mm and dome to neck ratio was 1.63 ± 1.3 mm. The mean number of SS FD implanted per aneurysm was 1.06 (range 1–3) with more than one SS FD implanted in 21 (7%) aneurysms. Modified Rankin Scale (mRS) of 0–2 was present in 206/213 (97%) patients at 6–12 month follow‐up. The complete aneurysm occlusion (RR 1) rate was 145/175 (83%) among subjects who had angiographic follow‐up at 6–12 months. Major stroke and death was encountered in 7 (2%) and 5 (1.8%) of the patients respectively. Conclusions : Our data represent the largest real‐world study using SS FD. These results corroborate its post‐marketing safety and efficacy for the treatment of intracranial aneurysms showing more favorable rates to the initial experience during SCENT trial.

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Abstract P331: Accuracy of CT Perfusion Core Estimates for Predicting Infarct Size in the SELECT Study

Stroke ◽

10.1161/str.52.suppl_1.p331 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Amrou Sarraj ◽

Bruce Campbell ◽

Clark Sitton ◽

Soren Christensen ◽

Shekhar Khanpara ◽

...

Keyword(s):

Cohort Study ◽

White Matter ◽

Infarct Size ◽

Ct Perfusion ◽

Infarct Volume ◽

Estimation Accuracy ◽

Ct Perfusion Imaging ◽

Ischemic Core ◽

The Difference ◽

Core Volume

Background: The accuracy of CT perfusion imaging for estimating the ischemic core has been questioned. Methods: In SELECT, a prospective cohort study of imaging selection, pts who achieved complete reperfusion after EVT were stratified on time from LKW to imaging acquisition and time from imaging to reperfusion. The difference between baseline CTP core volume and f/up infarct volume (on DWI after EVT) was classified as over-estimation (core >10 cc larger than infarct), adequate, or under-estimation (≥ 25 cc smaller). F/up DWI lesion was outlined using a semiautomated algorithm and co-registered to CTP. Results: Of 361 enrolled, 117 achieved TICI 3. F/up MRIs were acquired at 21 (13-30) hrs from EVT with median infarct volume of 16.4 cc, median 8.1 cc larger than baseline core. Median (IQR) time from imaging acquisition to groin puncture (GP) was 70 (50-95) min. Reperfusion was achieved at 35 (25-54) min of GP. The frequency of overestimation decreased as time LKW to imaging increased: < 90 min 6 (14%), 90 – 270 min 3 (6%) and > 270 min 1 (4%), and adequate estimation increased (< 90 min 21 (50%), 90 – 270 min 32 (65%) and > 270min 19 (73%), p for trend 0.048) Fig 1. Overestimation primarily occurred in pts imaged within 90 min who had short imaging to reperfusion times Fig 2. Volumetric correlation between pre-procedure and f/up imaging improved as LKW time to imaging acquisition increased; Spearman’s ρ: <90 min: 0.41 (p=0.007), 90-270 min: 0.35 (p=0.01), >270 min: 0.79 (p<0.0001). Spatially, overestimation occurred predominantly in white matter juxtacortical areas. Adjusting rCBF threshold from < 30% to < 20% in the 6 pts with overestimation ≤ 90 min from LKW resulted in adequate core estimation in all 6, Fig 3. Conclusion: In patients who achieve reperfusion, the correlation between baseline CTP ischemic core volume and f/up DWI volume improved as time LKW to imaging increased. Core estimation accuracy improved by using the < 20% CBF threshold for patients imaged within 90 minutes of LKW.

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Role of leukocyte free platelet rich plasma in planter fasciitis: a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175468 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5432

Author(s):

Chandre Shekhar ◽

Alamgir Jhan ◽

Ganesh Singh ◽

Pankaj Singh ◽

Shailendre S. Bhandhari

Keyword(s):

Placebo Group ◽

Functional Outcome ◽

Platelet Rich Plasma ◽

Functional Results ◽

Visual Analogue Scale Pain ◽

Functional Score ◽

Outcome Scores ◽

The Mean ◽

Post Graduate Institute

Background: Planter fasciitis, is by definition, inflammation of planter fascia. Most of the cases are well treated conservatively and a few responds to surgery only. Objectives of present study were evaluating the efficacy of a single injection of leukocyte free platelet rich plasma in plantar fasciitis and to derive a correlation between the clinical and radiological outcome.Methods: The present study consisted of 120 patients of bilateral (PF), (240 feet). These patients were divided into two groups PRP group of 60 patients and Placebo group of 60 patients. The study was conducted on patients attending Orthopaedics outpatient department Post Graduate Institute of Medial Education and Research (PGIMER) from July 2011 to June 2012. A primary efficacy criterion was changes from baseline in pain using (VAS). Functional results, level of satisfaction and outcome were measured by – AOFAS Foot Scale. Correlation of clinical with radiological outcome were performed.Results: There was a significant decrease in the visual analogue scale (pain score) in the PRP. Group while in placebo group it was increased significantly at the end of 6 month. Functional outcome scores were improved significantly from their baseline values in PRP group while in placebo group the mean functional score were deteriorated at 6 months follow up. There was no improvement seen in functional status with normal saline injection. In PRP group the mean heal pad thickness was reduced significantly at 6 months follow up while in placebo group was not changed significantly at 6 months follow up. Correlation between radiological parameters and VAS was found to be positive while it was found negative with other functional outcome scores like AOFAS.Conclusions: Platelet-rich plasma (PRP), which is a natural concentrate of autologous growth factors,plays a role in the regeneration process in treatment of (PF).

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Abstract TP397: Clinical And Functional Outcome Of Adult Patients Diagnosed With Moyamoya Disease In Childhood

Stroke ◽

10.1161/str.48.suppl_1.tp397 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

David Fam ◽

Nomazulu Dlamini ◽

Cheryl Jaigobin

Keyword(s):

Ischemic Stroke ◽

North America ◽

Natural History ◽

Functional Outcome ◽

Moyamoya Disease ◽

Vascular Event ◽

Moyamoya Syndrome ◽

The Mean

Background: Moyamoya disease is a progressive occlusive arteriopathy of the terminal ICA and its branches, leading to the formation of unstable collateral vessels. The disease is found worldwide, and is associated with a number of predisposing conditions, termed moyamoya syndrome. Currently there is a paucity of data on the natural history of moyamoya disease in North America, especially the long-term outcome of pediatric moyamoya. Objective: Our objectives were to determine the rate of recurrent TIA, ischemic stroke and intracerebral hemorrhage in patients presenting with pediatric Moyamoya disease and to assess long-term functional outcome. Methods: This study was a retrospective chart review of 52 patients presenting with pediatric moyamoya disease. We included patients aged 18 or older with a diagnosis of moyamoya disease or syndrome. All patients had confirmatory baseline vascular imaging (MRA or CTA +/- cerebral angiography). Baseline demographic variables and annual vascular event recurrence risk were obtained from the records. Modified Rankin Score (MRS) at presentation and last follow-up were determined from clinical records. Results: Of the original cohort, 34 patients were included for analysis. The mean age of the patients was 23.9 years. The mean age at presentation was 9 years (SD=4) with an average follow-up of 11.3 years (SD=5.1) for a total of 383 patient years. There was slight female predominance (1.4:1). Fifty percent of patients (17) presented with ischemic stroke. A total of 26 patients (76%) underwent surgery, with 7 (21%) requiring repeat surgery. The annual vascular recurrent event rate was 5.0% (19/383), which was not significantly different between surgical and non-surgical groups or between different moyamoya syndrome subtypes. Most of the recurrent events were TIA (annual recurrence 3.7%). There was no significant difference between initial MRS, MRS at last follow-up and mean change in MRS between surgical and non-surgical groups. Conclusion: Our study is the largest North American natural history study of pediatric moyamoya. Our observations indicate that pediatric moyamoya in North America have low recurrent vascular event rates and long-term functional outcomes are good, even in conservatively managed patients.

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Abstract TP52: Comparison of Two Methods of the Alberta Stroke Program Early CT Score

Stroke ◽

10.1161/str.48.suppl_1.tp52 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Alex J Linn ◽

Steve O’Donnell ◽

Adam de Havenon

Keyword(s):

Ct Perfusion ◽

High Reliability ◽

Scoring Systems ◽

Weighted Kappa ◽

Medical Decision ◽

Rater Agreement ◽

Clinical Tool ◽

Ct Angiogram ◽

The Mean

Introduction: Alberta Stroke Program Early CT Score (ASPECTS) is a validated clinical tool to predict early ischemic changes in acute ischemic stroke (AIS). In addition to scoring of non-contrast brain CT images (CT), head CT angiogram source images (CTA) have also been demonstrated as useful for scoring. We hypothesized that CTA ASPECTS would show superior inter-rater reliability as compared to CT ASPECTS, and that both would perform better in the setting of the favorable target mismatch (TM) profile on CT perfusion imaging (CTP). Methods: We reviewed AIS patients from 2010-2014 with an acute M1 middle cerebral artery occlusion that underwent CT, CTA, and CTP imaging at hospital admission. CT and CTA were independently scored by two experienced physician raters using the standard ASPECTS methodology. Inter-rater agreement was calculated with a weighted kappa. The cohort was then further stratified into either favorable or non-favorable TM profiles using volumetric measurements from the Olea Sphere software and the DEFUSE-3 definition of TM. Results: We included 68 patients. The mean±SD age was 62±18 years. 60% were men. The mean NIH stroke scale was 14.5±7.9. The median (IQR) follow-up modified Rankin Scale (mRS) was 3 (1,6). 37 of 68 (54%) patients had the TM profile and were significantly more likely to have lower follow-up mRS scores (z=3.5, p<0.001). Inter-rater agreement of CTA ASPECTS (kappa=0.82) was superior to CT ASPECTS (kappa=0.76). Patients with the TM profile demonstrated more reliable agreement on both CTA and CT ASPECTS scoring systems (kappa=0.79, 0.78), compared to those without the TM profile (kappa=0.71, 0.75). Discussion: We found that inter-rater agreement was higher for CTA ASPECTS as compared to CT ASPECTS and that both performed better in patents with the TM profile. Clinically this is important because it reaffirms the utility of CTA ASPECTS in this population of patients in which high reliability is paramount, as ASPECTS is often used in medical decision making when determining eligibility for medical and/or endovascular thrombolytic therapies.

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Abstract TP77: Impact of Time and Aspects on Clinical Core Mismatch in Large Vessel Occlusion Strokes

Stroke ◽

10.1161/str.51.suppl_1.tp77 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shashvat Desai ◽

Bradley J Molyneaux ◽

Marcelo Rocha ◽

Matthew Starr ◽

Tudor G Jovin ◽

...

Keyword(s):

Patient Selection ◽

Time Window ◽

Ct Perfusion ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Ct Head ◽

Ischemic Core ◽

The Impact ◽

Core Volume

Introduction: Patient selection for endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion (LVO) strokes in the 6-24-hour time window is dependent on delineating clinical core mismatch (CCM) as defined by DAWN trial criteria. In contrast, patient selection in the early window (0-6 hours) can be performed using ASPECTS on CT head. We aim to determine the prevalence of DAWN-CCM in LVO strokes and the impact of time and ASPECTS. Methods: Retrospective analysis of large vessel occlusion [internal carotid and middle cerebral artery-M1] strokes at a CSC. Consecutive patients who underwent CT perfusion or MRI within 120 minutes of CT head were included in the study (treated and untreated). Ischemic core volume was assessed using RAPID [IschemaView] and ASPECTS using automated ASPECTS [Brainomix]. CCM was defined using DAWN trial criteria [DAWN-CCM: NIHSS ≥10 and core <31 ml, NIHSS ≥20 and core <51 ml]. Results: A total of 116 patients were included. Mean age was 71 ±14 and 62% were females. Mean ischemic core volume and median ASPECTS were 46 ±65 ml and 8 (6-9), respectively. In patients with NIHSS score ≥10 (98), 57% had DAWN-CCM in the 0-24-hour window. Proportion of patients with DAWN-CCM in 6-24-hour window was 70% (6-12 hours), 50% (12-18 hours), and 50% (18-24 hours) [p=0.35]. Proportion of patients with DAWN-CCM by ASPECTS group was 88% (ASPECTS 9-10), 64% (ASPECTS 6-8) and 13% (ASPECTS 0-5) [p=<0.01] (Figure 1). Probability of DAWN-CCM declines by 7% for every 2 hours increase in TLKW to imaging, and by 13% for every 1-point decrease in ASPECTS. Conclusion: Approximately 57% of LVO strokes have clinical core mismatch. LVO strokes with DAWN-CCM decline with increasing time and decreasing ASPECTS. ASPECTS alone may be sufficient to identify patients with DAWN-CCM in a resource limited setting and avoid time consuming advanced imaging.

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