Exploring large vessel occlusion and ASPECT scores in hypertensive stroke: a retrospective study using pre-contrast computed tomography brain scan findings

Abstract

Background: Hypertension is one of the most common causes of stroke in Africa, including in sub-Saharan Africa. There is a lack of epidemiological and radiological information on hypertensive strokes. Objectives: We aimed to describe, classify and grade the pre-contrasted computed tomography brain (CTB) scan findings occurring in hypertensive stroke patients and to determine the inter- reader variability between three qualified radiologists. Method: This was a retrospective chart review of 205 pre-contrasted CTB scans in adult hypertensive patients presenting with a stroke at the Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, between 01 June 2019 and 31 March 2020. Results: There were 205 scans eligible to be included in this study. There were 67 (32.7%) normal and 138 (67.3%) abnormal scans. Ischaemic strokes were the most prevalent (43.5%), followed by lacunar infarctions (17.4%) and haemorrhagic strokes (13%). Stroke mimickers (n=32; 23.2%) were more common than lacunar infarctions and haemorrhagic strokes. Eight out of 19 patients with acute and hyperacute anterior circulation stroke (42.2%) presented with a favorable Alberta Stroke Program Early CT Score (ASPECTS) of 6 and above. Anterior circulation large vessel occlusion (LVO) was significant and occurred in six patients (31.6%) of the hyperacute and acute ischaemic strokes. The middle cerebral vascular territory was the most affected site for ischaemic strokes, haemorrhagic strokes and lacunar infarctions. Chronic ischaemic infarctions were the most common stage of presentation (n=25; 18.1%). In general, the interrater reliability for the three raters was substantial and there was almost perfect agreement. Conclusion: The pre-contrast CTB scan is essential in assessing hypertensive strokes because it risk stratifies, which aids in management and prognostication. Contribution: Detailed analysis of the pre-contrast computed tomography brain scan findings in hypertensive stroke patients, including interpretation of ASPECT scoring, LVO status, stage of ischaemic strokes and highlighting stroke mimickers.