Follow-up ASPECTS improves prediction of potentially lethal malignant edema in patients with large middle cerebral artery stroke

What would be VASTLY MORE IMPORTANT  is to create protocols that prevent this problem! Your mentors and senior researchers need re-education on the only goal in stroke: 100% recovery!

 Follow-up ASPECTS improves prediction of potentially lethal malignant edema in patients with large middle cerebral artery stroke

1. http://orcid.org/0009-0009-9890-1424Rebecca Stafford1,2,
2. http://orcid.org/0000-0002-4652-397XStefanos Chatzidakis3,4,
3. Ivy So Yeon Kim1,2,
4. Yihan Zhang1,3,
5. http://orcid.org/0000-0003-3729-4471Andriani Rina3,4,
6. Benjamin Brush5,
7. Asim Mian2,6,
8. http://orcid.org/0000-0002-9528-301XMohamad Abdalkader2,6,
9. http://orcid.org/0000-0002-2026-8333David M Greer1,2,
10. Stelios M Smirnakis3,4,7,
11. Steven K Feske1,2,
12. Josée Dupuis8,9,
13. http://orcid.org/0000-0003-2377-3025Charlene J Ong1,2

1. Correspondence to Dr Charlene J Ong, 85 East Concord St, Department of Neurology, Suite 1116 Boston Medical Center, Boston, MA 02118, USA; Cjong@bu.edu

Abstract

Background Recent studies have shown that follow-up head CT is a strong predictor of functional outcomes in patients with middle cerebral artery stroke and mechanical thrombectomy. We sought to determine whether total and/or regional follow-up Alberta Stroke Program Early CT Score (ASPECTS_fu) are associated with important clinical outcomes during hospitalization and improve the performance of clinical prediction models of potentially lethal malignant edema (PLME).

Methods We conducted a retrospective study of patients at three medical centers in a major North American metropolitan area with baseline and follow-up head CTs after large middle cerebral artery stroke between 2006 and 2022. We used multivariable logistic regression to test the association of total and regional ASPECTS_fu with PLME (cerebral edema related death or surgery), adjusting for total baseline ASPECTS, age, sex, admission glucose, tissue plasminogen activator, and mechanical thrombectomy. We compared existing clinical risk models with and without total or regional ASPECTS_fu using area under the curve.

Results In our 560 patient cohort, lower total ASPECTS_fu was significantly associated with higher odds of PLME when adjusting for confounders (OR 1.69, 95% CI 1.49 to 2.0), and improved model discrimination compared with existing models and models using baseline ASPECTS. Deep territory involvement (OR 2.46, 95% CI 1.53 to 4.01) and anterior territory involvement (OR 3.23, 95% CI 1.88 to 5.71) were significantly associated with PLME.

Conclusions Lower ASPECTS_fu and certain locations on regional ASPECTS_fu, including deep and anterior areas, were significantly associated with PLME. Including ASPECTS_fu information improved discrimination of established edema prediction models and could be used immediately to help facilitate clinical management decisions and prognostication.

Data availability statement

Data are available upon reasonable request. Deidentified data are available upon request and establishment of a data use agreement. Please email the corresponding author for access.

https://doi.org/10.1136/jnis-2023-021145

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