Short-and Medium-Term Outcome Study Of The Immediate Post-ASPECTS After Endovascular Recanalization In Patients With Acute Anterior Circulation Stroke

Objective Endovascular recanalization serves as a guideline-recommended method for the treatment of acute ischemic stroke patients with anterior-circulation large vessel occlusion（ACLVO-AIS）.However,nearly half of patients exhibit futile recanalization after thrombectomy,but factors predicting futile recanalization in the early postoperative period remain uncertain.Brain parenchymal hyperdensity on non-contrast computed tomography（NCCT）immediately after thrombectomy is a common clinical phenomenon,but its relationship with prognosis remains unclear.In this study,we aimed to investigate the relationship between brain parenchymal hyperdensity and final infarct volume,prognosis,and hemorrhagic transformation（HT）in ACLVO-AIS patients who underwent thrombectomy in the immediate postoperative period.Methods All enrolled patients achieved successful endovascular recanalization（m TICI 2b/3）after mechanical thrombectomy,and non-contrast computed tomography（NCCT）was performed immediately after the operation.The immediate post-thrombectomy ASPECTS（Post-ASPECTS）was evaluated semi-quantitatively according to the Alberta Stroke Program Early CT Score（ASPECTS）scoring criteria.HT refers to the persistence or further expansion of brain parenchymal hyperdensity shown on NCCT 24 hours after operation.HT was defined according to the European Cooperative Acute Stroke Study II（ECASS II）classification criteria.Study 1: We collected data from ACLVO-AIS patients who underwent endovascular recanalization from July 2018 to September 2019 in the First Affiliated Hospital of Anhui Medical University.The final infarct volume（IV-ASPECTS）was evaluated semi-quantitatively according to the ASPECTS scoring criteria.The modified Rankin Scale（m RS）score at discharge was divided into the good prognosis group（m RS score 0-2 points）and poor prognosis group（m RS score 3-6 points）.Linear correlation analysis and multiple linear regression analysis were used to find out the influence factors of IV-ASPECTS score and m RS score at discharge.Study 2: This study collected the clinical data,imaging data,and follow-up data of ACLVO-AIS patients who received endovascular recanalization from three hospitals within 10 hours.According to the 90-day m RS score,they were divided into the good prognosis group（m RS score 0-2 points）and poor prognosis group（m RS score 3-6 points）.According to the 90-day m RS score,they were divided into the non-death group（m RS score 0-5 points）and death group（m RS score 6 points）.They were divided into non-HT group and HT group according to the presence or absence of HT.Linear correlation,multivariable logistic regression,and receiver operating characteristic curve were used to analyze the influencing factors and best predictive values of 90-day prognosis,90-day death,and HT.Results Study 1: A total of 28 ACLVO-AIS patients were enrolled,13（46.4%）in the good prognosis group and 15（53.6%）in the poor prognosis group.There were 18 males（64.3%）and 10 females（35.7%）.Compared with the good prognosis group,patients in the poor prognosis group had higher baseline NIHSS score（Z =-3.004,P = 0.003）, baseline m RS score（Z =-2.529,P = 0.011）,NIHSS score at discharge（Z =-4.502,P < 0.001）,and lower Pre-ASPECTS score（Z =-2.136,P = 0.033）,Post-ASPECTS score（Z =-2.697,P = 0.007）and IV-ASPECTS score（Z =-3.376,P = 0.001）,and higher rate of HT（15.4% VS 80.0%,P = 0.002）,and longer hospital stay（t =-2.099,P = 0.036）.Correlation analysis results showed that Post-ASPECTS score was highly correlated with IV-ASPECTS score（r = 0.864,P < 0.01）;There was also a significant correlation between Post-ASPECTS score and m RS score at discharge（r =-0.619,P < 0.01）.Regression analysis showed that the Post-ASPECTS score was the main influencing factor of final infarct volume（β = 0.785,P < 0.001）and poor outcome at discharge（β =-0.399,P = 0.018）.Study 2: A total of 231 patients with ACLVO-AIS were enrolled.The 90-day good prognosis rate,90-day mortality rate,and HT rate were 57.1%,9.5%,and 40.6%,respectively.The Post-ASPECTS score can affect 90-day poor prognosis,90-day death,and HT.The best predictive value of the Post-ASPECTS score for 90-day poor prognosis,90-day death,and HT was 7.The specificities of Post-ASPECTS score for predicting HT,90-day poor prognosis,and 90-day death were 87.6%（AUC,0.804;P < 0.001）,87.1%（AUC,0.768;P < 0.001）,and 73.7%（AUC,0.748;P < 0.001）,with the positive predictive values were 75.8%,75.7%,and 21.4%,respectively.Conclusions Study 1: Post-ASPECTS score was highly linearly associated with IV-ASPECTS,and was a major influence of final infarct volume as well as poor outcome at discharge in ACLVO-AIS patients.Study 2: The best predictive value of the Post-ASPECTS score for 90-day poor prognosis,90-day death,and HT was 7,and it had high specificity and positive predictive value with the specificity of 87.1%,73.7%,and 87.6%,respectively,and positive predictive value of 75.7%,21.4%,and 75.8%,respectively.The Post-ASPECTS score is an independent predictor of infarct volume,short-and medium-term prognosis,and HT.Therefore,the Post-ASPECTS score is expected to become a simple and feasible effective index for early prediction of prognosis after endovascular recanalization.