Neuroimaging patterns of ischemic stroke and the drivers of dynamics in aspect score in Rwanda

Abstract

Background: Stroke is the second leading cause of death and the third leading cause of both death and disability worldwide. Clinical decision-making is supported by the use of imaging in such patients. For the purpose of determining and quantifying early ischemic changes on non-contrast brain computed tomography (CT), the Alberta Stroke Program Early CT Score (ASPECTS) was developed. ASPECT score is utilized to assist in patient selection for intra-arterial recanalization therapy and as a prognostic tool. The patients with very low ASPECT scores (0-3) are more prone to experience bleeding as a result of thrombolysis and are less likely to achieve a positive clinical result. Despite the high mortality and morbidity rate attributed to stroke, there is little available data on stroke in Rwanda. Most importantly, there is no available data from referral hospitals addressing the neuroimaging patterns of ischemic stroke and the drivers of dynamics in ASPECT score. Objective: This study investigated the neuroimaging patterns of ischemic stroke and the drivers of dynamics in ASPECT score in Rwanda for the period of January 2019 to December 2021. Methods: A retrospective cross-sectional study was conducted. Three hundred and eighty-nine (389) patients who underwent brain CT scans were recruited in the study done in the four referral hospitals in Rwanda. The data analysis was performed by SPSS version 21 and checked once more for omissions and errors before being analysed Results: The findings show that 77.1% were at least 51 years of age with an average of 62.89±19.19years. Furthermore, results show that 55.3% of the population were females and 44.7% were males. Regarding residence of study participants 237(60.9%) of patients with ischemic stroke were coming from rural area, while 152 (39.1%) live in urban areas. Among the study population ASPECT score of less than 7 was prevalent at 58.1% and the mean ASPECT score was 6.86±1.62. The majority of ischemic stroke patients in Rwanda avail themselves to imaging facilities between 1-7days post symptoms, while only 1% of them show up within the golden window of time within 3 hours of the stroke symptoms. Hypertension (AOR=2.034, 95% CI =1.258-3.288, P=0.011), the distance to the receiving referral hospital (AOR=1.772, 95% CI =1.0562.976, P=0.033), duration of symptoms before neuroimaging (AOR=0.514, 95% CI =0.280-0.943, P=0.031) and location of the lesion (AOR=0.289, 95% CI =0.102-0.818, P=0.032) significantly influence the occurrence of low ASPECT score in the study population. The ischemic stroke patients with low ASPECT scores (less than 7) were two times more likely to develop hemorrhagic transformation [AOR=2.661, 95%CI: 1.118-6.336, p<0.027]. Conclusion: Ischemic stroke trends more among females in the rural population. The dynamics of ASPECT score among patients with ischemic stroke are driven by hypertension, increased distance from the equipped hospital, and increased duration from symptoms onset