Published: 2020-03-26

Correlation between acute ischemic stroke onset with Alberta stroke program early CT score

Iskandar Nasution, Khairul Putra Surbakti, Netty Delvrita Lubis, Etiya Ekayana


Background: Alberta Stroke Program Early CT Score (ASPECTS) is a valid method for assessing early ischemic changes in the middle cerebral artery from a CT scan of patient with acute ischemic stroke. One of the factors that influence ASPECTS is stroke onset time, where a very subtle level of hypodensity in early onset can provide poor reliability on ASPECTS assessments. Aim of the study was to determine the relationship between the onset of acute ischemic stroke and ASPECTS.

Methods: This study used a cross-sectional design with Chi-Square method in patients with acute ischemic stroke and anterior circulation stroke treated in The Stroke Corner and Integrated Ward of Haji Adam Malik General Hospital during the months of February - May 2019. All patients were evaluated for ASPECTS and stroke onset at admission. Stroke onset was divided into 3 parts: Under 24 hours, 24 - <48 hours and 48-72 hours. ASPECTS value was assessed by 2 observers. Authors categorized the ASPECT value into 2 groups: Low (≤7) and High (˃7).

Results: Among 36 patients with Acute Ischemic Stroke, mean age was 55.7±13.9 years old, which male and female shares equal number by 18 persons (50%). Mean ASPECTS score was 7.2±2.0. This research found 5 patients (13.9%) with less than 24 hours onset and low ASPECTS score, 3 patients (8.3%) with 24 - <48 hours onset and low ASPECTS score, 7 patients (19.4%) with 24 - <48 hours onset and high ASPECTS score, 8 patients (22.2%) with 48-72 hours onset and low ASPECTS score, and 2 patients (5.6%) with 48-72 hours of onset and high ASPECTS score. Valuation of ASPECTS from both observers was considered as excellent (statistic K value = 0.9).

Conclusions: ASPECTS has a significant relationship with stroke onset (p=0.029) and the initial ischemic change will be seen more clearly with increasing stroke onset time.



Alberta stroke program early CT score, Ischemic stroke, Stroke onset

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Lahano AK, Chandio MA, Bhatti MI. Frequency of common modifiable risk factors of stroke. Gomal J Med Scienc. 2014;12(4):222-6.

Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014 Jan 18;383(9913):245-55.

MacKay J, Mensah GA. World Health Organization. Global Burden of Stroke. The Atlas of Heart Disease and Stroke. Available at: las_15_burden_stroke.pdf. Accessed 3 December 2019.

Yikilkan H, Serin K, Aypak C, Gorpelioglu S. Comorbid Diseases and Dyslipidemia Among Elderly Home Care Stroke Patients. Acta Medica. 2013;2:48-52.

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017 Mar;135(10):e146-603.

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. Neurol Asia. 2012 Jun 1;17(2):101-7.

Prakkamakul S, Yoo AJ. ASPECTS CT in acute ischemia: review of current data. Top Magn Reson Imag. 2017 Jun 1;26(3):103-12.

Rambe AS, Fithrie A, Nasution I and Tonam. Profile of Stroke Patients at 25 Hospitals in North Sumatra 2012 Hospital Based Survey. Neurona 2013;30(2):1-7.

Corso G, Bottacchi E, Tosi P, Caligiana L, Lia C, Veronese Morosini M, et al. Outcome predictors in first-ever ischemic stroke patients: a population-based study. Intern Scholarly Res Not. 2014; 1-8.

Ogbole GI, Owolabi MO, Ogun O, Ogunseyinde OA, Ogunniyi A. Time of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital. Annal Ibadan Postgraduate Med. 2015;13(1):23-8.

Khan M, Baird GL, Goddeau Jr RP, Silver B, Henninger N. Alberta Stroke Program Early CT Score infarct location predicts outcome following M2 occlusion. Front Neurol. 2017 Mar 14;8:98.