Introduction: This study investigates whether ASPECT score (Alberta Stroke Program Early CT Score) or distribution of acute infarction is associated with outcomes following intervention with the ADAPT technique. ADAPT is an aspiration first mechanical thrombectomy approach that has been established as the superior technique for acute ischemic stroke intervention.Our objective is to determine whether pre-intervention non-perfect ASPECT scores or the regional infarct distribution (cortical, subcortical, or cortical and subcortical) affects outcomes after thrombectomy with ADAPT.
Methods: This is a retrospective review from consecutive patients at a single tertiary referral center who underwent aspiration thrombectomy with ADAPT for acute MCA distribution infarcts between December 2012 and May 2015. Demographic, radiographic, angiographic, and clinical data were retrospectively collected from a prospectively maintained database of ischemic stroke patients at our institution (Medical University of South Carolina). Pre-intervention CT imaging was retrospectively reviewed by a blinded radiologist to calculate the ASPECT scores and to determine the distribution of infarction. Clinical outcomes were compared for subsets of patients depending upon ASPECT score and regional infarction distribution (cortical, subcortical, or cortical and subcortical).
Results: 154 patients (50% female and mean age 67) were treated for acute ischemic stroke with mechanical thrombectomy utilizing the ADAPT technique. Average presenting NIHSS was 15. Similar overall outcomes were achieved for patients with perfect and non-perfect ASPECT scores. Similar overall outcomes were also achieved for patients with ASPECTs of =6 compared to those with ASPECTs =7. Regional distribution of core infarction (i.e. Basal Gangila involvement) on the pre-intervention CT also did not correlate with worse outcomes.
Conclusions: A treatment algorithm for acute ischemic stroke which employs hardline ASPECTS thresholds or one which excludes patients with basal gangila infarcts might preclude patients who would potentially benefit from mechanical thrombectomy with ADAPT.
Patient Care: This research will contribute to a better understanding of when ADAPT thrombectomy is an appropriate treatment for AIS.
Learning Objectives: After reading, the audience should be able to describe how a treatment algorithm for acute ischemic stroke which employs hardline ASPECTS thresholds or one which excludes patients with basal gangila infarcts might preclude patients who would potentially benefit from mechanical thrombectomy with ADAPT.