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Research ArticleNeurointervention

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 April 2021, DOI: https://doi.org/10.3174/ajnr.A7096
S.M. Seyedsaadat
aFrom the Departments of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.)
cDepartment of Radiology (S.M.S.), Mayo Clinic, Jacksonville, Florida
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  • ORCID record for S.M. Seyedsaadat
A.A. Neuhaus
dRadcliffe Department of Medicine (A.A.N.), University of Oxford, Oxford, UK
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P.J. Nicholson
eDepartment 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 Departments of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.)
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C.A. Hilditch
eDepartment 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
fDepartment 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
gDepartment of Radiology (D.C.M.), Division of Neuroradiology, Cleveland Clinic, Cleveland, Ohio
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  • ORCID record for D.C. Mihal
T. Krings
eDepartment 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 Departments of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.)
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I. Mark
aFrom the Departments of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.)
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D.F. Kallmes
aFrom the Departments of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.)
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W. Brinjikji
aFrom the Departments of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.)
bNeurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
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J.D. Schaafsma
eDepartment 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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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 Apr 2021, 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 Apr 2021, DOI: 10.3174/ajnr.A7096
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