Journal Article

Early computed tomography-based scores to predict decompressive hemicraniectomy after endovascular therapy in acute ischemic stroke

Tsogkas, Ioannis, Knauth, Michael, Schregel, Katharina, Behme, Daniel, Liman, Jan, Psychogios, Marios-Nikos, Schnieder, Marlena, Maier, Ilko L., Bähr, Mathias

2017

Overview

Identification of patients requiring decompressive hemicraniectomy (DH) after endovascular therapy (EVT) is crucial as clinical signs are not reliable and early DH has been shown to improve clinical outcome. The aim of our study was to identify imaging-based scores to predict the risk for space occupying ischemic stroke and DH. Prospectively derived data from patients with acute large artery occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Predictive value of non-contrast cranial computed tomography (ncCT) and cerebral blood volume (CBV) Alberta Stroke Program Early CT score (ASPECTS) were investigated for DH using logistic regression models and Receiver Operating Characteristic Curve analysis. From 218 patients with EVT, DH was performed in 20 patients (9.2%). Baseline- (7 vs. 9; p = 0.009) and follow-up ncCT ASPECTS (1 vs. 7, p<0.001) as well as baseline CBV ASPECTS (5 vs. 7, p<0.001) were significantly lower in patients with DH. ncCT (baseline: OR 0.71, p = 0.018; follow-up: OR 0.32, p = <0.001) and CBV ASPECTS (OR 0.63, p = 0.008) predicted DH. Cut-off ncCT-ASPECTS on baseline was 7-, ncCT-ASPECTS on follow-up was 4- and CBV ASPECTS on baseline was 5 points. ASPECTS could be useful to early identify patients requiring DH after EVT for acute large vessel occlusion.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Biology and Life Sciences / Blood / Blood volume / Brain Ischemia - diagnostic imaging / Brain Ischemia - surgery / Cardiovascular system / Care and treatment / CAT scans / Cerebral blood flow / Cerebral Blood Volume / Clinical outcomes / Computation / Computed tomography / Decompressive Craniectomy / Endovascular Procedures - methods / Female / Humans / Ischemia / Logistic Models / Male / Medical imaging / Medicine and Health Sciences / Meta-analysis / Middle Aged / Neurology / Occlusion / Patient outcomes / Patients / Physical Sciences / Prognosis / Prospective Studies / Regression analysis / Regression models / Research and Analysis Methods / ROC Curve / Stroke / Stroke - diagnostic imaging / Stroke - surgery / Therapy / Tomography / Tomography, X-Ray Computed - methods / Vascular surgery / Veins & arteries