Acute stroke outcome potential risk stratification based on imaging criteria

More strict imaging based pacients selection could decrease mortality and severe neurological deficit after EVT treatment. The aim of our study was to analyze imaging-based criteria–computed tomography perfusion (CTP) core ASPECTS score and CT angiography collaterals pattern – before patient selection for reperfusion treatment (EVT) and evaluate three months functional outcome (modified Rankin scale -mRS) after treatment. We analyzed 208 patients in the mixed retrospective/prospective study (2015-2018) with large artery occlusion - 90 (43%) men and 118 (57%) women, and the median age was 72± 10.55 years. Two comparative initial CTP ASPECTS scoring groups were defined (≥ 7 and ≥ 6) and collaterals (good and poor) were used for patient evaluation in comparison with functional outcome (mRS). Majority of patients had MCA M1 segment occlusion 157 (75%) and 51 (25%) had ICA occlusion. Successful recanalization after EVT was 90% (TICI 2b-3) with mRS 0-2 after discharge and 3 months 62 (30%) vs 83 (40%), p<0.001, respectively. Small size CTP core (ASPECTS ≥ 7) with good collateral pattern showed higher potential risk OR 4.651 times, CI 95% (2.3 - 9.2) for good outcome (mRS 0-2) compared with CTP -core ASPECTS <7, p <0.001. After re-categorization of patients groups by ASPECTS ≥6 with good collaterals we revealed OR 4.738 times higher potential risk for 3 months good outcome (CI 95% (2.4-9.5),p<0.001) compared with CTP core ASPECTS <6, p<0.001. We found that CTP - core ASPECTS lower score at admission by each single point increases mortality rate 1.3 times (OR 1.346 times CI 95%[1.06-1.7]). Good clinical outcome in acute ischemic stroke shows significantly higher rate if initial imaging - based biomarkers are applied in patient selection for EVT: CTP core ASPECTS ≥6 with presence of good collaterals in contary with ASPECTS <6 has significant impact of each score point on mortality regardless collaterals.