Neurointervention.  2017 Mar;12(1):20-30. 10.5469/neuroint.2017.12.1.20.

Alberta Stroke Program Early CT Score in the Prognostication after Endovascular Treatment for Ischemic Stroke: A Meta-analysis

• Ryu CW
• Shin HS
• Park S
• Suh SH
• Koh JS
• Choi HY

• KMID: 2371755
• DOI: http://doi.org/10.5469/neuroint.2017.12.1.20

Abstract

PURPOSE
The Alberta Stroke Program Early CT Score (ASPECTS) was devised to quantify the extent of early ischemic changes in the middle cerebral artery territory on brain CT. We performed a systematic review and meta-analysis of studies that presented clinical outcomes and baseline ASPECTS in ischemic stroke patients managed with endovascular methods to validate the use of ASPECTS for risk prognostication.
MATERIALS AND METHODS
We searched the MEDLINE, EMBASE, and Cochran databases for observational or interventional studies that reported clinical outcomes and baseline ASPECTS in ischemic stroke patients treated with endovascular methods. Data were pooled to perform a meta-analysis for comparisons of clinical outcomes between high and low ASPECTS patients.
RESULTS
A meta-analysis of 13 studies (six observational and seven interventional) revealed favorable outcomes (mRS sore 0-2 at 90 days) for high baseline ASPECTS (odds ratio=2.22; 95% CI: 1.74-2.86).
CONCLUSION
High ASPECTS is a predictor of favorable outcome after endovascular therapy for ischemic stroke.

Keyword

ASPECTS score; Stroke; Thrombectomy; Reperfusion therapy

MeSH Terms

Alberta*
Brain
Humans
Middle Cerebral Artery
Stroke*
Thrombectomy

Figure

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  Fig. 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram describing selection process for included studies.

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  Fig. 2 Clinical outcomes of endovascular treatments in ischemic stroke patients with high ASPECTS vs. low ASPECTS A. Meta-analyses of high ASPECTS (>7) vs. low ASPECTS (≤7) for favorable clinical outcome (modified Rankin scale score 0-2) (A). The relative size of the data markers indicates the weight of each study's sample size. The included trials for functional outcome are divided into subgroups according to study design (prospective randomized controlled or single-arm trials and observational case series). B. A funnel plot with all points evenly distributed on both sides of the solid vertical line indicates no publication bias. C. Subgroup analysis of favorable outcomes of endovascular treatments in ischemic stroke patients with high ASPECTS vs. low ASPECTS. The included trials for functional outcome are divided into subgroups according to the methods of endovascular therapy (dominant intraarterial thrombolysis and dominant intraarterial thrombectomy). One study (23) which did not clearly present the endovascular methods was excluded from subgroup analysis for endovascular methods. D. Scatterplots of the relationship between the rate of ICA occlusion and log odds ratio. The size of the bubbles indicates the weight of each study in the meta-analysis. The trend line indicates the degree to which the log odds ratio decreases as the rate of ICA occlusion in subjects increases.

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  Fig. 3 Mortality and symptomatic intracranial hemorrhage of endovascular treatments in ischemic stroke patients with high ASPECTS vs. low ASPECTS.A. Mortality at 90 days.B. Symptomatic intracranial hemorrhage.

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  Fig. 4 Comparison among very low, intermediate, and high ASPECTS.A. Favorable outcome (modified Rankin scale score 0-2 at 90 days) of endovascular treatments in ischemic stroke patients with ASPECTS ≤4 vs. ASPECTS >4.B. Favorable outcome of endovascular treatments in ischemic stroke patients with intermediate ASPECTS (5 or 6 to 7) vs. high ASPECTS (8-10).

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