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ASPECTS predicts DH need after endovascular therapy

15 Mar 2017
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Patients requiring decompressive hemicraniectomy (DH) following endovascular therapy (EVT) can be reliably identified by Alberta Stroke Program Early Computed Tomography Score (ASPECTS), a new study reports.

The study involved retrospective clinical data of 218 patients with acute ischaemic stroke of the anterior circulation and undergoing EVT. ASPECTS was determined using retrieved imaging data.

Logistic regression was used to determine the predictive value of noncontrast cranial CT (ncCT) and cerebral blood volume (CBV) ASPECTS on the need of DH.

Of the 218 patients, 20 subsequently received DH within a mean period of 40.5 hours from baseline imaging. Those who received DH were younger (p<0.001), had higher National Institutes of Health Stroke Scale (NIHSS) scores (p=0.095) and showed lower rates of hyperlipoproteinemia (p=0.029).

In terms of EVT parameters, the DH group showed longer symptom-to-final angiogram times (p=0.036) and lower rates of successful recanalization (p=0.005).

Moreover, compared to the non-DH group, patients who received DH had higher baseline ncCT (p=0.009), follow-up ncCT (p<0.001) and CBV (p<0.001) ASPECTS. Menon collateral scores (CS) were also lower in patients who underwent DH (p=0.054).

After controlling for possible confounders, logistic regression analysis showed that the strongest predictor for DH was ncCT ASPECTS after 72 hours (odds ratio [OR], 0.32; 95 percent CI, 0.17 to 0.059; p<0.001) followed by CBV ASPECTS (OR, 0.63; 0.45 to 0.89; p=0.008) and baseline ncCT ASPECTS (OR, 0.71; 0.47 to 1.07; p=0.018). CS did not show a significant association in this analysis (OR, 0.63; 0.45 to 0.89; p=0.10).

Further studies are warranted to validate and confirm these results in a larger population, according to researchers.

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