Clinical Need

Background

The successful treatment of suspected ischemic stroke patients, requires an immediate response and fast clinical treatment decisions to be made.

Pre-hospital phase

Patients admitted for a suspected stroke require swift recognition of symptoms and rapid referral to a hospital with acute stroke treatment facilities.

Patient Evaluation

Algorithms for treatment in acute ischemic stroke use information obtained from clinical examination, patient history, laboratory values and a scan of the patient’s brain, which uses CT in most centres.

Key aims of initial emergency non-contrast CT scan:

  • Exclude intracranial haemorrhage and rule out non-stroke processes, like tumour and other intracranial pathologies that can mimic stroke
  • Identify early stroke features and the extent of the infarction

Image interpretation of the CT scan, commonly uses ASPECTS to identify damage to 10 MCA territories and stratify patients for treatments like thrombolysis and/or endovascular treatment.

Appropriate treatment

The focus of immediate care for patients who have suffered an acute ischemic stroke is to re-establish blood flow (reperfusion) to the brain. Clinical methods used for this include thrombolysis, which dissolves blood clots, and thrombectomy that mechanically removes them.

An ASPECTS score of >6 is seen as a good candidate for thrombectomy (Powers et al., 2015).

  • Evaluation must be rapid due to a time sensitive treatment pathway
  • Manual interpretation is prone to intra- and inter-examiner variability in applying the ASPECTS stroke scale
  • The application of the ASPECTS scoring system requires training
  • Correct assessment of the extent of ischemic damage is crucial, before treatment decisions are made

How e-ASPECTS helps

  • Automatically assesses the 10 MCA regions and displays an ASPECTS score
  • Visually highlights regions of acute and non-acute ischemic damage
  • Reduces inter-examiner variability
  • Designed to save time in decision making