8th Baltic Congress of Radiology

Interventional Radiology

oral abstract

Alberta Stroke Program Early CT Score (ASPECTS) is widely used to quantify early ischaemic changes of acute stroke patients and may be useful in identifying those who will potentially benefit from treatment, although it is difficult to put together radiological signs and symptoms with patient's clinical condition. The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit, whereas The Modified Rankin Scale (mRS) is used to measure the degree of disability in patients who have had a stroke. The aim of the study is to determine correlations between a patient’s radiological and neurological rating scores before and after endovascular thrombectomy. Keywords: acute stroke, endovascular thrombectomy, ASPECTS (The Alberta Stroke Program Early CT Score), NIHSS (National Institutes of Health Stroke Scale), mRS (The modified Rankin Scale).

Retrospective study included patients hospitalized at the Riga East Clinical University Hospital in the period between 1st of January 2020 and 31st May 2022 with acute neurological deficit, examined by head CT non-enhanced and contrast enhanced scan in emergency department. Patients with NIHSS and ASPECT score more than 6 and proven large vessel occlusion were selected for following mechanical thrombectomy. The data included patients age, sex, anatomical localizations of thrombosis, ASPECT scores in preoperative and postoperative non-enhanced CT, NIHSS and mRS scores before endovascular thrombectomy (Pre-EVT) and before the patient's discharge (Post-EVT). Statistical analysis of data was performed using IBM SPSS 26. Statistical significance was considered at p ≤ 0.05.

54 patients with anterior circulation stroke were included in the study. The median age was 74 ± 10,4 (SD) years. The results indicated statistically significant, moderate negative correlations between Pre-EVT ASPECT score and mRS 6 outcome (r=-0.41; p<0.002); between Post-EVT ASPECT and mRS 6 outcome (r=-0.55; p<0.001) and between Post-EVT ASPECT score and NIHSS before discharge (r=-0,44; p<0.02). Weak negative correlations were found between Post-EVT ASPECT score and mRS before discharge (r=-0.36; p<0.01); additionally, was found weak positive correlations between preoperative ASPECT score and age (r=0,32; p<0.02) and between Pre-EVT and Post-EVT ASPECT scores (r=0.38; p<0.005). It was found that with Pre-EVT ASPECT score 10, thrombectomy helped to decrease mean NIHSS value by 5,67 points; with Pre-EVT ASPECT score of 9 - by 5,29 and with score of 8 - by 4,8. Thrombectomy for patients with Pre-EVT ASPECT of 7 and 6 did not yield any NIHSS improvements. Among 30 patients with Pre-EVT ASPECT score 10, Post-EVT NIHSS values decreased for 19 patients (63.33%), did not change for 7 patients (23.3%) and increased for 4 patients (13.3 %). Post-EVT mRS values decreased for 14 of 30 patients (46.67 %). Among 7 patients with initial ASPECT score = 9, only 4 had reduced Post-EVT NIHSS values and 3 had reduced mRS values. Among 8 patients with Pre-EVT ASPECT score below 9 (from 8 to 6), only 2 patients had Post-EVT NIHSS score improvement and 4 had mRS score improvement.

Correlation between Pre-EVT and Post-EVT ASPECT scores may indicate that endovascular thrombectomy performed in patients with low ASPECT score preoperatively will not improve in follow up CT scans. Lower Post-EVT ASPECT scores correlates with poor neurological outcome and higher NIHSS and mRS scores.

Evaluation of two years of endovascular thrombectomy practice at the Riga East Clinical University Hospital for patiens with acute neurological deficit. The aim of the study was to determine correlations between a patient’s radiological and neurological rating scores before and after endovascular thrombectomy, comparing ASPECT (The Alberta Stroke Program Early CT Score) with NIHSS (National Institutes of Health Stroke Scale) and mRS (The modified Rankin Scale).

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