Abstract 156: Poor Correlation Between Non-contrast CT (NCCT) Aspects and CT Perfusion (CTP)-derived Ischemic Core Volumes

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Introduction and Objectives: The best imaging method for selecting patients for thrombectomy remains unknown. We aim to evaluate the correlation between ASPECTS and RAPID automated CT perfusion (CTP) ischemic core volumes.

Methods: This was a retrospective review of a prospectively collected interventional database. We included patients from January 2011-February 2015 with MCA-M1, MCA-M2 or ICA-terminus occlusions that underwent good quality RAPID CTP. The correlation between ASPECTS and CTP-derived ischemic core volumes (CBF<30% contralateral hemisphere) was analyzed.

Results: A total of 188 were included. Mean age was 62.4±14.8, 51% were males, 71% had hypertension, 34% dyslipidemia, 33% atrial fibrillation, 21% diabetes, and 37% received IV-tPA. Mean baseline NIHSS was 17.1±5.4 and ASPECTS 7.7±1.5. Time from last-known-normal to groin puncture was 6.9±4.3 hours. Sixty-one percent had MCA-M1, 21% MCA-M2, and 18% ICA-terminus occlusions. Seventy-two percent were treated with stent-retrievers, leading to 82% mTICI 2b-3 reperfusion, 9% parenchymal hemorrhages, 54% mRS0-2 and 11% mortality at 90 days. The correlation between ASPECTS and CTP-derived ischemic core was weak (rho 0.27; p<0.01). The attached figure demonstrates the very wide variability of ischemic core volumes across specific ASPECTS.

Conclusion: There is wide variability of CTP-derived ischemic core volumes within specific ASPECTS. Patient selection may significantly be affected by the imaging selection method.

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