Relationship between ASPECTS-region and clinical outcome in patients with large vessel occlusion stroke: a post-hoc analysis of randomized clinical trial

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BACKGROUND: The relationship between the infarct region and prognosis can assist clinicians in perioperative decision-making. However, the time (early or extended window) of the stroke may also influence the identification of prognostically relevant regions. We aim to determine whether topological information captured by CT ASPECTS contributes prognostic value in different time windows. METHODS: A post-hoc analysis of the DEVT and RESCUE BT studies was conducted. Pretreatment ASPECTS was evaluated by Fast-Processing of Ischemic Stroke software. Patients who had infarcts in at least one ASPECTS region (ASPECTS ≤ 9) were included and categorized according to treatment time window (early, 0-6 hours versus extended, 6-24 hours from last known well to puncture). The primary outcome measure was poor clinical prognosis (90-day modified Rankin Scale score of 3-6). Multivariable logistic regression analysis was performed to determine the association between lesion topography and prognosis after endovascular treatment at each time window. RESULTS: A total of 1040 patients (mean age 68 years, 58.7% male) were included in this cohort analysis, with 564 in the early (265 with good prognosis versus 299 with poor prognosis) and 476 in the extended (218 with good prognosis versus 258 with poor prognosis) time window. For the early time window strokes, involvement of the insula (OR: 1.636, 95% CI: 1.130-2.367), caudate nucleus (OR: 1.730, 95% CI: 1.012-2.957), and the M6 (OR: 1.773, 95% CI: 1.041-3.022) were independent factors associated with poor prognosis at 90 days after adjusting for age, hypertension, diabetes, baseline NIHSS, and the time from onset to puncture. In the extended window, the M3 (OR: 2.153, 95% CI: 1.110-4.175), and the M5 (OR: 1.775, 95% CI: 1.190-2.649) were independent prognostic factors. CONCLUSIONS: Different infarct regions have varying predictive power for poor outcomes in large vessel occlusion stroke patients with different time windows. This outcome may help to identify treatment-eligible patients who are in greatest need of rapid reperfusion treatment.

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