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Research ArticleInterventional

Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke

S.M. Seyedsaadat, A.A. Neuhaus, P.J. Nicholson, E.C. Polley, C.A. Hilditch, D.C. Mihal, T. Krings, J. Benson, I. Mark, D.F. Kallmes, W. Brinjikji and J.D. Schaafsma
American Journal of Neuroradiology June 2021, 42 (6) 1104-1108; DOI: https://doi.org/10.3174/ajnr.A7096
S.M. Seyedsaadat
aFrom the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
bDepartment of Radiology (S.M.S.), Mayo Clinic, Jacksonville, Florida
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A.A. Neuhaus
cRadcliffe Department of Medicine (A.A.N.), University of Oxford, Oxford, UK
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P.J. Nicholson
dDepartment of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
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E.C. Polley
aFrom the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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C.A. Hilditch
dDepartment of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
eDepartment of Neuroradiology (C.A.H.), Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
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D.C. Mihal
fDepartment of Radiology (D.C.M.), Division of Neuroradiology, Cleveland Clinic, Cleveland, Ohio
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  • ORCID record for D.C. Mihal
T. Krings
dDepartment of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
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J. Benson
aFrom the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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I. Mark
aFrom the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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D.F. Kallmes
aFrom the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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W. Brinjikji
aFrom the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
gDepartment of Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
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J.D. Schaafsma
dDepartment of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
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    FIGURE.

    Illustration of ASPECTS, showing 10 regions in 1 hemisphere. C indicates caudate; IC, internal capsule; L, lentiform; I, insula. Reproduced from Neuhaus et al25 with permission from BMJ Publishing Group Ltd.

Tables

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    Table 1:

    Predictive value of ASPECTS regions for mRS at 90 days

    RegionOR of Poor Outcome95% CIP Value
    Overall
        M10.380.14–0.99.047
        M21.550.77–3.26.234
        M30.690.24–2.00.487
        M42.941.09–9.46.046
        M51.870.84–4.51.141
        M61.660.52–6.01.407
        Lentiform0.930.52–1.66.803
        Insula1.751.08–2.85.023
        Caudate3.261.33–8.82.013
        Internal capsule0.760.29–2.03.575
    Right hemisphere
        M10.240.05–0.94.048
        M21.980.73–5.71.189
        M30.480.11–1.99.309
        M43.700.87–21.8.100
        M51.360.42–4.68.615
        M63.710.72–29.4.148
        Lentiform0.870.39–1.93.734
        Insula1.670.82–3.46.162
        Caudate2.740.81–10.5.117
        Internal capsule1.390.33–6.63.659
    Left hemisphere
        M10.570.14–2.51.438
        M21.700.56–5.94.372
        M31.190.21–8.27.843
        M42.880.69–19.6.193
        M52.800.81–13.2.135
        M60.700.10–5.04.717
        Lentiform1.250.53–3.10.613
        Insula1.740.88–3.49.112
        Caudate3.200.83–16.6.118
        Internal capsule0.500.13–1.98.312
    • View popup
    Table 2:

    Comparison of total ASPECTS between patients with caudate or insular infarct with the rest of cohort

    Total ASPECTS (Mean) (SD)P Value
    In the presence of insular infarction (n = 96)7.29 (1.34)<.0001
    In the absence of insular infarction (n = 257)8.97 (1.2)
    In the presence of caudate infarction (n = 172)7.65 (1.34)<.0001
    In the absence of caudate infarction (n = 181)9.34 (0.99)
    • View popup
    Table 3:

    Predictive value of ASPECTS regions for mRS at 90 days, stratified by recanalization status

    RegionOR of Poor Outcome95% CIP Value
    TICI 2b/3
        M10.280.09–0.83.025
        M21.870.84–4.41.137
        M30.560.17–1.75.318
        M43.541.26–11.9.024
        M51.890.79–4.92.167
        M61.590.47–5.87.463
        Lentiform0.980.53–1.81.935
        Insula1.691.01–2.85.048
        Caudate4.021.51–12.2.008
        Internal capsule1.000.35–3.05.994
    TICI 3
        M10.0930.00–1.23.064
        M22.180.56–10.00.279
        M30.500.06–4.07.511
        M43.080.88–12.74.091
        M53.660.88–19.49.089
        M68.550.95–209.20.092
        Lentiform0.830.33–2.02.679
        Insula1.870.86–4.12.116
        Caudate14.863.22–114.94.002
        Internal capsule0.520.10–2.38.404
    • View popup
    Table 4:

    Predictive value of ASPECTS regions for sICH

    RegionOR of sICH95% CIP Value
    M10.820.20–5.57.805
    M21.490.47–5.93.531
    M31.000.19–8.26.999
    M41.070.27–7.25.935
    M51.040.31–4.88.950
    M60.560.11–4.46.524
    Lentiform1.370.49–4.44.572
    Insula0.800.34–1.89.612
    Caudate0.510.15–1.97.299
    Internal capsule0.500.14–2.08.301
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American Journal of Neuroradiology: 42 (6)
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S.M. Seyedsaadat, A.A. Neuhaus, P.J. Nicholson, E.C. Polley, C.A. Hilditch, D.C. Mihal, T. Krings, J. Benson, I. Mark, D.F. Kallmes, W. Brinjikji, J.D. Schaafsma
Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke
American Journal of Neuroradiology Jun 2021, 42 (6) 1104-1108; DOI: 10.3174/ajnr.A7096

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Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke
S.M. Seyedsaadat, A.A. Neuhaus, P.J. Nicholson, E.C. Polley, C.A. Hilditch, D.C. Mihal, T. Krings, J. Benson, I. Mark, D.F. Kallmes, W. Brinjikji, J.D. Schaafsma
American Journal of Neuroradiology Jun 2021, 42 (6) 1104-1108; DOI: 10.3174/ajnr.A7096
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