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Abstract Details

Predicting Risk of Malignant Stroke Post Thrombectomy in Anterior Circulation Stroke using ASPECT-PASS Score (A-P Score), a Retrospective Cohort Study
Cerebrovascular Disease and Interventional Neurology
P4 - Poster Session 4 (8:00 AM-9:00 AM)
13-008

A retrospective cohort study was performed to determine the likelihood of malignant stroke after mechanical thrombectomy via a novel scoring scale using ASPECT score and number of arterial-passes. This prediction score is designed to help clinicians take early measures. 
Malignant stroke is defined as a large MCA infarct with mass effect that develops during the first 5 days following presentation and is associated with approximately 80% mortality. Previous studies have shown an association of low ASPECT and high number of passes with poor outcome.

We performed a retrospective cohort analysis on 80 patients with anterior circulation stroke who underwent mechanical thrombectomy at our hospital. We analyzed the likelihood of developing malignant stroke post thrombectomy in the first 5 days following successful recanalization (TICI >2b).  Malignant stroke is defined as severe symptoms secondary to edema as evidenced by midline shift, cistern engorgement, and hemorrhagic conversion. Patients with ASPECT 0-5 were excluded.

We used two variables to predict the outcome: ASPECT score and number-of-passes. We used the equation ASPECT score minus number-of-passes (A-P) to arrive at a single number to predict the risk of malignant stroke. A-P scoring scale ranged from 0-9. We used logistic regression for statistical analysis. Other variables (door-to-groin time, groin-to-first pass, and recanalization) were adjusted.

Our study showed a statistically significant inverse relationship of A-P score and risk of malignant stroke. The coefficient of -1.2 and probability of 23% (p-value .006) implies 23 % increase in risk of malignant stroke with every point decrease in A-P score. Approximately 90% of patients with A-P score < 5 developed malignant stroke in our study.
A-P score can help predict malignant stroke post thrombectomy even after successful recanalization. Thus, A-P score of < 5 suggests high risk.  A-P can assist clinicians to take early measures, and thereby prevent worse outcomes.
Authors/Disclosures
Avirag Goswami, MD (northern light EMMC)
PRESENTER 		Dr. Goswami has nothing to disclose.
Juan Solano, MD Dr. Solano has nothing to disclose.
Jonathan Dissin, MD (.) Dr. Dissin has received stock or an ownership interest from GlaxoSmithKline. Dr. Dissin has received stock or an ownership interest from Abbvie.
Aparna M. Prabhu, MD Dr. Prabhu has nothing to disclose.