Topographic Assessment of Acute Ischemic Changes for Prognostication of Anterior Circulation Stroke

BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.