Comparison of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) between Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis Alone Versus Combined with Mechanical Thrombectomy at Chonburi Hospital
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Research suggests that a higher Alberta stroke program early computed tomography score (ASPECTS) is associated with better outcomes after recombinant tissue plasminogen activator (rt-PA) treatment, highlighting the important role of early computed tom
ography (CT) brain scans in selecting patients for thrombolytic therapy. In addition, a recent study suggests that adding mechanical thrombectomy can significantly improve outcomes for patients with moderate to severe symptoms and low ASPECTS scores, as it allows for restoration of blood flow in patients who may have a poor prognosis with rt-PA alone.
OBJECTIVES: To compare ASPECTS between acute ischemic stroke patients treated with intravenous thrombolysis alone versus combined with mechanical thrombectomy at Chonburi Hospital, to further develop and improve the treatment for better efficiency.
METHODS: A retrospective cohort of 180 patients with acute ischemic stroke (stroke fast track stroke onset < 4.5 hours) who underwent CT brain scans at Chonburi Hospital. from January 1, 2020 to December 31, 2024, were studied.
RESULTS: The results showed that patients who received rt-PA alone had an ASPECTS of 8.90±1.29 compared to the rt-PA plus thrombectomy group, which had ASPECTS of 8.50±0.93. The sample size was calculated using the STATA program to compare two independent means using power 0.08, significance level 0.05, and a one-sided t-test. The proportion of patients undergoing mechanical thrombectomy to those who received rt-PA alone was 0.3. The National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess neurological severity by emergency medicine physicians and neurologists.
CONCLUSION: Pre-treatment CT brain assessment using ASPECTS can help in deciding the appropriate treatment methods for acute ischemic stroke patients (with fast track strokr onset<4.5 hours) and improve patient care.
Thaiclinicaltrials.org number, TCTR20250826005
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Rattanakorn D, Tangkanakul C, Nithinan S, Suwanwela NC, Hanchaiwiboonkul S, Nilanon T, editors. Current practical guide to stroke management. 2nd ed. Bangkok: Thai Stroke Society; 2011.
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008;371:1612-23.
Capirossi C, Laiso A, Renieri L, Capasso F, Limbucci N. Epidemiology, organization, diagnosis and treatment of acute ischemic stroke. Eur J Radiol Open [Internet]. 2023 [cited 2025 Feb 2];11:100527. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10582298/pdf/main.pdf
Tiamkao S. Incidence of cerebrovascular disease in Thailand. Thai Journal of Neurology 2022;39(2):39-46.
Pawakul K. 30 years of ischemic stroke treatment: past, present, and future. North-Eastern Thai Journal of Neuroscience 2023;18:196-209.
Phuttharak W, Sawanyawisuth K, Sangpetngam B, Tiamkao S. CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes. Jpn J Radiol 2013;31:701-5.
Tiamkao S. 13 years - learning and development of stroke fast track in Thailand. Journal of Health Systems Research 2023;17:191-99.
Demeestere J, Garcia-Esperon C, Lin L, Bivard A, Ang T, Smoll NR, et al. Validation of the national institutes of health stroke scale-8 to detect large vessel occlusion in ischemic stroke. J Stroke Cerebrovasc Dis 2017;26:1419-26.
Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol 2006;5:603-12.
Quinn TJ, Taylor-Rowan M, Coyte A, Clark AB, Musgrave SD, Metcalf AK, et al. Pre-stroke modified Rankin scale: evaluation of validity, prognostic accuracy, and association with treatment. Front Neurol [Internet]. 2017 [cited 2025 Feb 2];8:275. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5468801/pdf/fneur-08-00275.pdf
Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000;355:1670-4.
National Institutes of Neurological Disorders and Stroke. NIH Stroke Scale [Internet]. 2025 [cited 2025 Mar 1]. Available from: https://www.nihstrokescale.org/Index.html
Jha B, Kothari M. Pearls & oy-sters: hyperdense or pseudohyperdense MCA sign: a Damocles sword? Neurology [Internet]. 2009 [cited 2025 Mar 17];72(23):e116-7. Available from: https://www.neurology.org/doi/pdfdirect/10.1212/wnl.0b013e3181a92b3b
Zanzmera P, Srivastava P, Garg A, Bhatia R, Singh M, Tripathi M, et al. Prediction of stroke outcome in relation to Alberta stroke program early CT score (ASPECTS) at admission in acute ischemic stroke: A prospective study from tertiary care hospital in north India. Neurology Asia 2012;17:101-7.
Phuttharak W, Sawanyawisuth K, Sangpetngam B, Tiamkao S. CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes. Jpn J Radiol 2013;31:701-5.
Scott JN, Buchan AM, Sevick RJ. Correlation of neurologic dysfunction with CT findings in early acute stroke. Can J Neurol Sci 1999;26:182-9.
Srinivasan A, Goyal M, Al Azri F, Lum C. State-of-the-art imaging of acute stroke. Radiographics [Internet]. 2006 [cited 2025 Jun 9];26 Suppl 1:S75-95. Available from: https://doi.org/10.1148/rg.26si065501
