Baseline ASPECTS and e-ASPECTS Correlation with Infarct Volume and Functional Outcome in Patients Undergoing Mechanical Thrombectomy

Background and purpose: The role of Alberta Stroke Program Early CT score (ASPECTS) in predicting which patients are likely to benefit from endovascular therapy (EVT) is not well defined. An automated software (e-ASPECTS) has been created to solve its poor interrater reliability. We aim to evaluate correlation between radiologist (Rx) and e-ASPECTS scoring with cerebral blood volume (CBV) infarct core and with final infarct volume; as well as with long-term functional outcome.

Methods: We included patients with acute ischemic stroke and large vessel occlusion who underwent EVT. We measured baseline radiologist (Rx) ASPECTS and e-ASPECTS, and baseline CBV infarct core on CT perfusion. Final infarct volume was measured on 24-hour control CT.

Results: We included 184 patients, in which 82.1% of patients achieved complete recanalization. Median Rx-ASPECTS/e-ASPECTS was 9 (IQR 8-10 vs. IQR 7.75-10) and mean CBV lesion was 29.51 (±47.41) mL. Correlation (r_s ) between ASPECTS and e-ASPECTS was .44 (P < .01). Both ASPECTS scores correlated with CBV after 180 minutes of symptom onset (r_s = -.41 vs. -.54, P < .01) and with final infarct volume in patients with complete recanalization (r_s = -.40 vs. -.43, P < .01). In a logistic regression, either Rx-ASPECTS, e-ASPECTS, and CBV (OR 1.60 vs. 1.87 vs. .96; P < .05) predicted a low infarct volume. Rx-ASPECTS and e-ASPECTS also predicted functional independence (mRS 0-2) at 3 months (1.52 vs. 1.37; P < .05).

Conclusion: ASPECTS and e-ASPECTS showed a mild correlation with CBV. Rx-ASPECTS, e-ASPECTS, and CBV predicted a low infarct volume after thrombectomy in recanalized patients but only Rx-ASPECTS and e-ASPECTS predicted functional independence at 3 months.