BACKGROUND:Recent trials confirmed the effectiveness of endovascular therapy in patients with large ischemic cores. Yet the optimal neuroimaging modalities to define large core remains unclear. We tried to address this question by comparing the functional outcomes in patients receiving thrombectomy selected by either noncontrast computed tomography Alberta Stroke Program Early Computed Tomography Score (ASPECTS) or computed tomography perfusion (CTP).METHODS:This study retrospectively selected patients enrolled in the International Stroke Perfusion Registry between August 2011 and April 2022. Patients with acute stroke with large vessel occlusion in anterior circulation treated with endovascular therapy were included. All received both CTP and noncontrast computed tomography. The primary outcome was defined as poor functional outcome represented by a modified Rankin Scale score of 5 to 6 at 3 months. Large cores were defined in terms of either (1) noncontrast computed tomography ASPECTS ≤5 or (2) core volume ≥70 mL on CTP.RESULTS:A total of 1115 patients were included in the analysis, of which 90 patients had ASPECTS ≤5 (8.1%) and 97 patients CTP core ≥70 mL (8.7%). A fair agreement between ASPECTS and CTP with a κ value of 0.31 (0.21–0.40) was found. Compared with patients with neither CTP nor ASPECTS large cores, those with only ASPECTS-defined large cores (ie, ASPECTS ≤5; n=56) did not have a higher adjusted odds of poor outcome (29%; odds ratio, 1.84 [0.91–3.73]; P=0.089). However, patients with CTP large core but not ASPECTS-defined large core (n=63) had a higher adjusted odds of poor outcome (60%; odds ratio, 3.91 [2.01–7.60]; P<0.001). In time-stratified subgroup analysis (>6 versus ≤6 hours), ASPECTS showed no discriminative difference between ≤5 and >5 in poor outcome for patients receiving endovascular therapy within 6 hours.CONCLUSIONS:CTP core ≥70 mL-defined large cores are more predictive of poor outcome than ASPECTS ≤5-defined core in endovascular therapy patients, particularly within 6 hours after stroke onset.

中文翻译：

---

与 ASPECTS 定义的大核心相比，CTP 定义的大核心可以更好地预测血管内治疗的不良结果

背景：最近的试验证实了血管内治疗对大面积缺血核心患者的有效性。然而，定义大核心的最佳神经影像学方式仍不清楚。我们试图通过比较通过非对比计算机断层扫描艾伯塔省卒中计划早期计算机断层扫描评分 (ASPECTS) 或计算机断层扫描灌注 (CTP) 选择的接受血栓切除术的患者的功能结果来解决这个问题。 方法：本研究回顾性地选择了参加国际研究的患者2011年8月至2022年4月期间的卒中灌注登记。纳入了接受血管内治疗的前循环大血管闭塞的急性卒中患者。所有患者均接受了 CTP 和非造影计算机断层扫描。主要结果定义为功能结果不佳，以 3 个月时改良 Rankin 量表评分为 5 至 6 分为代表。大核心定义为 (1) 非造影计算机断层扫描 ASPECTS ≤ 5 或 (2) CTP 上核心体积≥70 mL。 结果：分析中总共纳入了 1115 名患者，其中 90 名患者的 ASPECTS ≤ 5 (8.1%) 和 97 名患者 CTP 核心≥70 mL (8.7%)。发现 ASPECTS 和 CTP 之间相当一致，κ 值为 0.31 (0.21–0.40)。与既没有 CTP 也没有 ASPECTS 大核心的患者相比，仅具有 ASPECTS 定义的大核心的患者（即 ASPECTS ≤ 5；n=56）没有更高的不良结果调整赔率（29%；赔率比，1.84 [0.91] –3.73]；P =0.089）。然而，患有 CTP 大核心但非 ASPECTS 定义的大核心的患者 (n=63) 具有较高的调整后不良结果几率（60%；优势比，3.91 [2.01–7.60]；P <0.001）。在时间分层亚组分析（>6 小时与 ≤6 小时）中，ASPECTS 显示 6 小时内接受血管内治疗的患者不良结局在 ≤5 和 >5 之间没有区别。结论：CTP 核心 ≥70 mL 定义的大核心是在血管内治疗患者中，比 ASPECTS ≤ 5 定义的核心更能预测不良结果，特别是在中风发作后 6 小时内。