Clinical Utility of Electronic Alberta Stroke Program Early Computed Tomography Score Software in the ENCHANTED Trial Database

Background: The clinical utility of e-ASPECTS, an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke.

Methods: All baseline noncontrast CT scans of anterior circulation acute ischemic stroke patients in the alteplase dose arm of the ENCHANTED trial were reviewed (poor quality and >6 mm slice thickness excluded). e-ASPECTS scores were correlated with baseline NIHSS and 90-day mRS, with multivariable logistic regression to determine predictive ability for disability outcomes and symptomatic intracranial hemorrhage.

Results: Of 2426 CT images, 1480 (61%) were included (median e-ASPECTS 9; 77% with good scores). Lower e-ASPECTS (per 1-point decrease) was significantly associated with higher baseline NIHSS (r −0.31) and 90-day poor outcome (r −0.27). Adjusted ORs for 90-day outcomes were 0.91 (mRS 2–6), 0.89 (mRS 3–6), and 0.86 (death); for symptomatic intracranial hemorrhage, 0.87.

Conclusions: e-ASPECT scores from thin CT slices (≤6 mm) were highly correlated with baseline neurological severity and independently predicted functional recovery and adverse outcomes in acute ischemic stroke.