Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

ASPECTS rule of thumb for Acute stroke thrombectomy: Practical or Misleading?
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
040
To investigate the ability to discriminate outcomes of a commonly used heuristic in patient selection for stroke thrombectomy.
Heuristics are widely used in Medicine and often guide medical decision making under uncertainty and time constraints. However, if they are usually perceived as useful, data supporting them is lacking, and they may lead to erroneous decisions with devastating consequences at the individual patient level.
All consecutive patients with anterior circulation LVOS presenting at a tertiary care center between 1/2014-11/2018 were included. The heuristic was defined as follows: “Only treat patient with an ASPECTS equal or higher than the first digit of their age”. Patient were dichotomized into 2 groups according to whether they met the latter. Baseline characteristics and outcomes were compared.

1011 patients were included of which 88 (8.7%) did not meet the rule of thumb selection criteria. The latter were older (p<0.001), had higher rates of atrial fibrillation (p=0.015), higher NIHSS (p<0.001) and lower ASPECTS (p<0.001).

In terms of outcomes, they had higher rates of parenchymal hematomas (20.5% vs 8.9%, p<0.001) and 90-day mortality (34.1% vs 13.9%, p<0.001) as well as lower rates of good outcome (mRS 0-2) (21.6% vs 51.5%, p<0.001).

After adjustment for potential confounders on multivariate analysis, meeting the heuristic criteria was associated with lower 90-day mortality (aOR 0.43, 95% CI[0.22-0.85], p=0.014) but was not an independent predictor of either good outcome or parenchymal hematoma.
Our analysis shows that ASPECTS rule of thumb might be useful in aiding selection for stroke thrombectomy. However, we caution against oversimplification and recommend using all available data at the time of decision making.
Authors/Disclosures
Mehdi Bouslama, MD (University at Buffalo Neurosurgery)
PRESENTER 		Dr. Bouslama has nothing to disclose.
Diogo C. Haussen, MD Dr. Haussen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Stryker. Dr. Haussen has received stock or an ownership interest from Viz AI.
Michael R. Frankel, MD (Emory Univ School of Med/Dept of Neuro) The institution of Dr. Frankel has received research support from Nico Corporation, Inc.
Raul G. Nogueira, MD (UPMC Stroke Institute) Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.