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Advisor(s)
Abstract(s)
Introdução: No Acidente vascular cerebral (AVC) isquémico, a trombectomia mecânica é uma importante ferramenta terapêutica. O score ASPECTS, calculado em estudos de Tomografia Computorizada (TC), é utilizado na seleção de doentes para este procedimento, necessitando de ser superior a 6 para inclusão. Os estudos de angio-TC, que são realizados simultaneamente com a TC na admissão do doente, também possibilitam a avaliação do parênquima e frequentemente demonstram áreas de hipodensidade, que podem ser diferentes das identificadas nos estudos TC. Assim, surge a questão de qual dos métodos de imagem é um melhor preditor do enfarte final, informação que pode ser muito relevante, não apenas na seleção dos doentes, mas também na determinação do prognóstico.
Objetivos: Comparar o score ASPECTS em estudos de TC com o mesmo score em estudos de angio-TC, aquando a admissão de doentes com AVC isquémico agudo, submetidos a procedimentos de revascularização vascular, para predição da área de enfarte final. Será ainda avaliada a relação entre os scores e o grau de recanalização e determinar-se-á a reprodutibilidade inter-observador das medições efetuadas.
Métodos: Estudo coorte retrospetivo, de doentes com AVC isquémico agudo da circulação anterior submetidos a procedimento de trombectomia no serviço de Imagiologia Neurológica do CHLN-EPE, entre 2019 e 31 de janeiro de 2020. De forma independente e cega para os dados clínicos, efetuou-se o cálculo do score ASPECTS nos estudos de TC e angio-TC à admissão e na TC às 24h. Os valores do score foram também comparados entre os subgrupos de diferentes graus de recanalização e analisados quanto à reprodutibilidade inter-observador.
Resultados: Neste estudo, foram incluídos 99 doentes. Os valores do score ASPECTS na angio-TC foram, em média, mais próximos dos valores na TC às 24h. Nos doentes com TICI ≥ 2B, os valores do score na TC e angio-TC foram, em média, mais próximos dos valores na TC às 24h comparativamente aos doentes com TICI < 2B. Os valores do score ASPECTS apresentaram uma boa reprodutibilidade inter-observador.
Discussão e conclusão: O valor do score ASPECTS calculado no estudo de angio-TC é um melhor preditor da área final de enfarte, relativamente ao valor obtido com a TC. Nos doentes com TICI ≥ 2B, tanto a TC como a angio-TC apresentaram um maior valor preditor comparativamente aos doentes com menor grau de recanalização. O score calculado na angio-TC pode vir a ser utilizado para uma melhor seleção dos doentes e determinação do prognóstico.
Introduction: Mechanical thrombectomy is an important therapeutic tool in ischaemic stroke. ASPECTS score is calculated based on Computed Tomography (CT) studies and it allows to select patients to this procedure. Patients with a score above 6 are included. CT angiogram studies are also obtained at the patient admission, allowing to evaluate the parenchyma and to determine hypodense areas, which might be different from those seen in CT. Thus, it becomes very important to determine which method is better at predicting the final infarct zone. This information is relevant not only when selecting patients to these procedures but also when establishing their prognosis. Purpose: This study aims to compare the ASPECTS score applied to CT and angiogram studies in the acute phase of ischaemic stroke in patients selected to revascularization procedures in order to predict the final infarct zone, defined by the 24-hour CT ASPECTS score. Furthermore, it aims to evaluate the relation between the score and the recanalization level and to determine the inter-rater reliability of these measurements. Methods: Retrospective cohort study. Patients included had a history of anterior territory ischaemic stroke, treated with mechanical thrombectomy in the Neurologic Radiology service from CHLN-EPE, from 2019 to January 2020. ASPECTS score was calculated in the admission CT and angiogram and in the 24-hour CT. This score was also compared among different recanalization level subgroups. The inter-rater reliability was determined. Results: This study included 99 patients. ASPECTS score in angiogram was, in average, closer to the ASPECTS in the 24-hour CT. In TICI ≥ 2B subgroup, ASPECTS score was, in average, closer to the 24-hour CT in both CT and angiogram when compared to the group with TICI < 2B. A good inter-rater reliability was obtained. Discussion and conclusion: The ASPECTS score determined in CT angiogram studies is a better predictor of the final infarct zone, when compared to the ASPECTS score in CT studies. Both CT and angiogram had a better predictive value in TICI ≥ 2B subgroup when compared to TICI < 2B subgroup. The score calculated in CT angiogram can be used in the future for a better patient selection and when establishing prognosis.
Introduction: Mechanical thrombectomy is an important therapeutic tool in ischaemic stroke. ASPECTS score is calculated based on Computed Tomography (CT) studies and it allows to select patients to this procedure. Patients with a score above 6 are included. CT angiogram studies are also obtained at the patient admission, allowing to evaluate the parenchyma and to determine hypodense areas, which might be different from those seen in CT. Thus, it becomes very important to determine which method is better at predicting the final infarct zone. This information is relevant not only when selecting patients to these procedures but also when establishing their prognosis. Purpose: This study aims to compare the ASPECTS score applied to CT and angiogram studies in the acute phase of ischaemic stroke in patients selected to revascularization procedures in order to predict the final infarct zone, defined by the 24-hour CT ASPECTS score. Furthermore, it aims to evaluate the relation between the score and the recanalization level and to determine the inter-rater reliability of these measurements. Methods: Retrospective cohort study. Patients included had a history of anterior territory ischaemic stroke, treated with mechanical thrombectomy in the Neurologic Radiology service from CHLN-EPE, from 2019 to January 2020. ASPECTS score was calculated in the admission CT and angiogram and in the 24-hour CT. This score was also compared among different recanalization level subgroups. The inter-rater reliability was determined. Results: This study included 99 patients. ASPECTS score in angiogram was, in average, closer to the ASPECTS in the 24-hour CT. In TICI ≥ 2B subgroup, ASPECTS score was, in average, closer to the 24-hour CT in both CT and angiogram when compared to the group with TICI < 2B. A good inter-rater reliability was obtained. Discussion and conclusion: The ASPECTS score determined in CT angiogram studies is a better predictor of the final infarct zone, when compared to the ASPECTS score in CT studies. Both CT and angiogram had a better predictive value in TICI ≥ 2B subgroup when compared to TICI < 2B subgroup. The score calculated in CT angiogram can be used in the future for a better patient selection and when establishing prognosis.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Keywords
Acidente vascular cerebral isquémico Tomografia computadorizada Angio-TC Score ASPECTS Imagiologia