Change in CT appearance over time correlates with outcomes more than initial CT findings in ischemic stroke
Sun et al. performed a retrospective cohort study assessing the rate of pretreatment Alberta Stroke Program Early CT Scores (ASPECTS) decay and its ability to predict good outcome. ASPECTS scores <8 have been associated with worse functional outcomes in patients being treated for acute ischemic stroke; however, this is a static radiologic variable. The authors assessed the rate of decline in ASPECTS scores between outside hospital original CT and accepting center second CT. In a logistic regression model, they found that greater ASPECTS decay significantly predicts worse functional outcome as measured by 90 day mRS. Additionally, absolute ASPECTS decay (OR 0.043; 95% CI 0.004 to 0.471; p=0.01) was a stronger predictor of outcome compared to static pretreatment ASPECTS (OR 0.64; 95% CI 0.38 to 1.04; p=0.075). Based on these results, the authors postulate that this metric may serve as a surrogate physiologic biomarker and help stratify patients who will benefit most from intra-arterial therapy.