Background and aims. Prediction of functional outcome after acute ischemic stroke with large vessel occlusion is currently unsatisfactory despite the availability of multiple prognostic markers. We aimed to evaluate the performance of integrated ASPECTS and collateral status scores in predicting stroke outcome.
Methods. From our prospective database we selected consecutive acute ischemic stroke patients admitted within 6 hours from symptom onset, with anterior circulation LVO, treated according to clinical guidelines. Baseline ASPECTS score and collateral status score (poor=0, intermediate=1, good=2) were evaluated blindly and independently by two experienced raters and integrated into a combined score. Stroke outcome was measured at 90 days with mRS. Logistic regression was performed and a receiver-operating curve (ROC) was built.
Results. 54 acute ischemic stroke patients with median age 74 (IQR 66-77), baseline NIHSS 18 (IQR 15-22) were included. All patients received acute treatment. Tissue viability (TV) score was built multiplying the three-level (0-to-2) collateral vessel score by normalized ASPECTS score (ASPECTS ≤6 being 0; ASPECTS 10 being 2). TV score significantly predicted good functional outcome (mRS ≤2) independently of onset-to-imaging time and treatment type (p=0.03; odds ratio 1.50 [95% CI: 1.04 to 2.21]).
ROC curve was built (AUC 0.686); TV scores lower than optimal threshold of 1.5 units displayed 61.8% (CI: 43.6–77.8) sensitivity and 70.8% (CI: 48.9–87.4) specificity for poor functional outcome.
Conclusions. Tissue viability score combining ASPECTS and collateral status displayed promising value in predicting outcome in large vessel occlusion stroke.