O-021 Evaluation of Baseline CT ASPECTS in Perfusion-guided Selected Patients for Intra-arterial Reperfusion Therapy
Notice bibliographique
Résumé
Background and Purpose Appropriate patient selection in acute ischaemic stroke (AIS) is central for improving patient outcomes following intra-arterial (IA) reperfusion therapy (thrombolysis/mechanical thrombectomy). Perfusion imaging with CTP/MR DWI-PWI has been utilised increasingly to identify subpopulations with acceptable risk-benefit profiles for reperfusion, avoiding futile or harmful recanalisation. Earlier studies reported to have prognostic value of baseline Alberta Stroke Program Early CT Score (ASPECTS) of >7 in determining good functional outcomes following IA reperfusion. We investigated baseline CT ASPECTS in AIS patients selected for IA reperfusion therapy based on perfusion mismatch profiles. Furthermore, we studied the predictive value of CT ASPECTS for clinical outcomes following recanalisation. Materials and Methods In a multicentre review, all AIS patients that underwent IA thrombolysis/thrombectomy between January 2010 and September 2012 were studied retrospectively for the following inclusion criteria: baseline NIHSS >8, presentation <8 hours from symptom onset, CTA/MRA verified M1-M2 MCA occlusion, and favourable perfusion (CTP/MR DWI-PWI) mismatch profile. Patient demographics, medical comorbidities, time from symptom onset to recanalisation, final recanalisation (TICI scale), and clinical outcomes (90 day mRS score) were obtained. One neuroradiologist conducted blinded scoring of ASPECTS for all baseline noncontrast CT scans. For evaluation of inter-rater reliability, scores by another neuroradiologist were used and analysed using Intraclass Correlation Coefficient (ICC) and Bland and Altman method. ASPECTS scores were dichotomised into >7 and ≤7 for primary analysis. Chi-square, Mann-Whitney U and student t tests were used for univariate analyses as appropriate. To obtain the optimal cut-off ASPECTS for discriminating patients with favourable outcomes, receiver operating characteristic (ROC) curve analysis was performed. Results Seventy-one consecutive patients (39 female/32 male patients with mean age of 71.2 ± 15.5 years) met inclusion criteria for analysis. Successful recanalisation (TICI > 2b/3) was achieved in 38 patients (53.5%), highly correlating with good functional outcomes (mRS 0–2) in 43 patients (60.6%) (P < 0.001). No significant difference was observed between ASPECTS reading (P=0.9) with good inter-rater reliability (ICC=0.80, 95% confidence interval: 0.66 to 0.87). Patients with ASPECTS >7 (n=43) and ≤7 (n=28) were comparable in baseline characteristics,medical history, and treatment related variables (age, P=0.8; sex, P=0.8; baseline NIHSS score, P=0.2; diabetes, P=0.8; atrial fibrillation, P=1.0; hyperlipidemia, P=1.0; hypertension, P=0.8; recanalisation, P=0.6; time from symptom onset to recanalisation, P=0.7). Relatively high ASPECTS correlated with perfusion-based patient selection with mean and median baseline ASPECTS of eight. However, no significant correlation was observed between baseline ASPECTS and final clinical outcomes (P=0.5). Additionally, baseline ASPECTS score >7 did not correlate with final outcome in patients with successful recanalisation (P=0.4). The ROC curve analysis demonstrated a cut-off point of eight for discrimination of final outcome, but with poor predictive value (sensitivity=65.1%; specificity=28.6%; P=0.8, AUC=0.51). Conclusion Our results indicate favourable baseline CT ASPECTS correlate with favourable perfusion mismatch profiles and may represent an equivalent surrogate for primary patient selection in IA reperfusion therapy. However, CT ASPECTS did not clearly predict good functional outcomes independent of recanalisation, suggesting other confounding variables such as core infarct volume versus eloquence may impact clinical outcomes and have to be elucidated. Disclosures A. Honarmand: None. M. Soltanolkotabi: None. S. Prabhakaran: None. M. Hurley: None. O. Rahman: None. A. Shaibani: None. S. Ansari: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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