Low (0-5) Alberta Stroke Program Early Computed Tomography Score on Admission Predictive of Worse Functional Outcome after Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion

Low (0-5) Alberta Stroke Program Early Computed Tomography Score on Admission Predictive of Worse Functional Outcome after Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Low (0-5) Alberta Stroke Program Early Computed Tomography Score on Admission Predictive of Worse Functional Outcome after Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Jinze Li, Jinfeng Duan, Luojin Zhang, Jingshu Chen, yang Duan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2067919/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND AND PURPOSE We examined functional outcomes of mechanical thrombectomy (MT) procedures following anterior circulation large vessel occlusion (ACLVO)-related acute ischemic strokes (AIS). Results were based on admission non-contrast computed tomography (NCCT) studies, using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as standard metric. METHODS Qualifying subjects were consecutive patients (N = 327) at a single center undergoing MT for ACLVO-related AIS. Each was grouped according to ASPECTS status on admission, determined from NCCT images by two physicians. Primary clinical endpoint was functional independence, assessed via modified Rankin Scale (mRS) at 90 days. Secondary endpoints were vessel recanalization (ie, modified Thrombolysis in Cerebral Infarction [mTICI] score), symptomatic intracranial hemorrhage (sICH), and mortality. RESULTS In this study population (mean age, 63.6 ± 12.5 years; women, 29.3%; median baseline National Institute of Health Stroke Scale [NIHSS] score, 15.2 ± 4.5), patients were stratified by ASPECTS tier at presentation, either 0–5 (n = 43) or 6–10 (n = 284). Multivariate logistic regression showed a relation between ASPECTS values ≤ 5 and lesser chance of 90-day functional improvement (OR = 1.40, 95% confidence interval [CI]: 1.00-5.80; p = 0.049), once adjusted for age, baseline NIHSS score, diabetes mellitus, atrial fibrillation/flutter, current/prior alcohol intake, HbA1c concentration, D-dimer level, occlusion of internal carotid artery (ICA), occlusion of ICA and middle cerebral artery (ICA + MCA), numbers of device passes, and successful recanalization. CONCLUSIONS ASPECTS values ≤ 5 correspond with worse long-term functional improvement (mRS scores > 2) in patients undergoing MT for ACLVO-related AIS. Other independent determinants of functional outcomes after MT are age, baseline NIHSS score, HbA1c concentration, and successful recanalization. mechanical thrombectomy stroke imaging acute ischemic stroke CT outcomes Figures Figure 1 Figure 2 Figure 3 Introduction Domestic and foreign studies have validated the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as a standardized quantitative metric, reflecting the extent of infarction in instances of acute anterior circulation large vessel occlusion (ACLVO) [ 1 , 2 ]. Recent reports have also demonstrated that this simple and reliable measure may serve to identify the most suitable patients for endovascular therapy and function as a prognostic index [ 3 ]. According to American Heart Association/American Stroke Association guidelines, the standard of care in adult patients with ASPECTS values ≥ 6 and large-vessel occlusion is endovascular therapy [ 4 , 5 ]. However, much of the research on mechanical thrombectomy (MT) has excluded patients with lower ASPECTS values (≤ 6 or 7), failing to fully address the prognostic utility of ASPECTS in MT-treated patients [ 6 , 7 ]. In the present study, we compared ASPECTS values of NCCT studies on admission with clinical consequences of MT (including successful recanalization, functional improvement, symptomatic intracranial hemorrhage [sICH], and mortality), hoping to facilitate the planning of MT procedures. Methods Patient selection This was a single-center retrospective observational analysis of 327 consecutive patients with ACLVO-related AIS treated by MT between January 2016 and August 2022. The hospital's institutional review board approved our study protocol. Eligible MT-treated subjects met the following inclusion criteria: (1) adult ≥18 years; (2) availability of non-contrast computed tomography (NCCT) imaging done on admission; and (3) proximal anterior circulation occlusion involving internal carotid artery (ICA) or M1/proximal M2 branch of middle cerebral artery (MCA), as shown by computed tomography angiography (CTA) or digital subtraction angiography (DSA). The following were grounds for study exclusion: (1) prior severe stroke, with baseline National Institutes of Health Stroke Scale (NIHSS) score≤8 or baseline modified Rankin Scale (mRS) score≥1; (2) farction on baseline CT; or (3) other brain abnormalities, such as tumors or trauma (shown in Fig. 1). Data collection We retrieved baseline patient characteristics (age and sex), medical history (including prior stroke, coronary artery disease, atrial fibrillation/flutter, hypertension, hyperlipidemia, or diabetes mellitus), and lifestyle habits (current/prior tobacco use, alcohol intake), as well as clinical parameters on admission (ie, NIHSS score, diastolic [DBP] and systolic [SBP] blood pressure readings, glycosylated hemoglobin [HbA1c] concentration, D-dimer level, and presence of hyperdense middle cerebral artery sign [HMCAS] or signs of early infarction on NCCT) and intravenous injection of tissue plasminogen activator (tPA) from electronic medical records. Other clinical variables, including trial of ORG 10172 in acute stroke treatment (TOAST) classification, occlusive location, stroke-onset to puncture time, number of device passes, and use of balloon-guided catheter or angioplasty/stenting, were also recorded. All NCCT studies were performed by Discovery CT 750 HD scanner (GE Healthcare, Chicago, IL, USA) at the following settings: tube voltage, 100 kV; tube current, 120 mA; collimator width, 40mm; field of view, 25cm; layer thickness, 5mm; layer spacing, 5mm. Two neuroradiologists blinded to clinical outcomes separately determined ASPECTS values for each patient. Inconsistencies were resolved by imaging reviews, reaching consensus decisions through discussion. In ASPECTS determinations, MCA vascular supply has 10 defined territories [1], including seven regions of caudate nucleus and layers below (M1, M2, M3, insula [I], lenticular nucleus[L], caudate nucleus [C], and posterior limb of internal capsule [IC]) and three areas of cerebral cortex above the nucleus(M4, M5, and M6). Maximum score is 10 points, subtracting 1 point for each injured area (shown in Fig. 2). Clinical outcomes The primary study endpoint was long-term functional independence, measured by mRS at 90 days. Secondary endpoints were successful vascular reperfusion immediately following MT (ie, modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b or 3); symptomatic intracranial hemorrhage (sICH), indicated by≥4-point decline in NIHSS score or CT evidence of hemorrhage within 24 hours post-MT; and mortality. Statistical analysis All computations were driven by standard software (SPSS v22.6; IBM Corp, Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. The Shapiro-Wilk test was applied to determine normality of distributions. Continuous variables with non-normal distributions were expressed as mean ± standard deviation (SD) or median (interquartile range [IQR]) values. Normally distributed continuous variables were subjected to Student’s t -test, assesssing non-normal variables by Mann-Whitney U test and categorical variables by Fisher’s exact or χ2 test. Multivariate logistic regression analysis served to identify independent predictors of clinical outcomes. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), setting significance at p <0.05. Results Baseline patient characteristics The 327 qualifying patients were grouped according to ASPECTS tier (0–5, 43; 6–10, 284). Mean age was 63.6 ± 12.5 years, and 96 (29.3%) were women. A summary of group parameters is provided in Table 1. Members of the low-scoring (0–5) group exhibited more extreme presentations than did high-scoring (6–10) group members (mean baseline NIHSS score: 18.1 ± 5.2 vs 14.7 ± 4.2; p < 0.001). Likewise, HMCAS positivity (76.7% vs 60.2%; p = 0.037) and signs of early infarction (93.0% vs 59.2%; p < 0.001) were significantly more prevalent in the low-scoring (vs high-scoring) group. Clinical outcomes Clinical outcomes are shown by group in Table 2 . Unlike the high (6-10) ASPECTS tier, low-tier (0-5) members were less inclined to show good clinical outcomes (mRS scores 0-2) at 90 days (32.6% vs 49.3%; p =0.041) (shown in Fig. 3), demonstrating higher rates of sICH (39.5% vs 21.8%; p =0.012) and mortality (18.6% vs 8.8%; p =0.047). However, successful reperfusion rates did not differ significantly in the two groups (76.7% vs 74.6%; p =0.0768). Predictors of worse functional outcomes (mRS scores >2) Table 3 contains a listing of unfavorable prognosticators, including older age ( p <0.001), higher baseline NIHSS score ( p <0.001), histories of diabetes mellitus ( p <0.001) or atrial fibrillation/flutter ( p =0.014), current/prior alcohol intake( p =0.034), increased HbA1c concentration ( p <0.001), elevated D-dimer level ( p <0.001), occlusion of ICA ( p =0.003), non-occlusion of ICA+MCA ( p =0.024), number of device passes( p =0.024), successful reperfusion ( p 2) at 90 days (OR=1.40, 95% CI: 1.00-5.80; p =0.049) emerged, once adjusted for age, NIHSS score, diabetes mellitus, atrial fibrillation/flutter, current/prior alcohol intake, HbA1c concentration, D-dimer level, occlusion of ICA, occlusion of ICA+MCA, number of device passes, and successful reperfusion ( Table4 ). Discussion The Discussion/Conclusion should provide an evaluation of the results. There should be a clear discussion of the implications, significance, and novelty of the results presented and whether the data support or contradict previous studies. Present findings indicate that ASPECTS values ≤ 5 on admission NCCT studies reduce the likelihood of long-term functional independence and increase the odds of sICH and mortality after MT in patients with ACLVO-related AIS. On the other hand, higher ASPECTS values (6–10) herald significantly better clinical outcomes and carry less risk of death. These associations proved significant in multivariate regression analysis, with other independent predictors emerging as well. ASPECTS is a simple and convenient, topographic method of semiquantitatively gauging early ischemic core infarct volume and is deemed strongly predictive of clinical outcomes in the setting of AIS [ 1 ]. Typically, it is a stipulation for enrollment in various randomized intravascular treatment trials. Because past efforts seemed to restrict the merits of MT to patients with ASPECTS values ≥ 6, subsequent clinical trials have tended to exclude those with lesser scores [ 6 – 8 ]. Indeed, a recent meta-analysis of such studies undertaken by Phan et al to explore ASPECTS as a basis for revascularization suitability has demonstrated the prognostic favorability of a higher (vs lower) ASPECTS status in the course of endovascular thrombectomy [ 8 ]. However, more and more efforts are showing that patients with lower ASPECTS values may well benefit from MT under certain conditions [ 9 – 12 ]. In a subgroup analysis of the MR CLEAN randomized phase 3 trial, patients with ASPECTS values of 5–7 were regarded as acceptable candidates for endovascular therapy, otherwise weighing potential treatment benefit and cost-effectiveness of endovascular therapy (in conjunction with various influential factors) at values of 0–4 [ 3 ]. An analysis from the STRATIS Registry, conducted by Zaidat et al and aimed at impacts of age and low (0–5) ASPECTS status (ie, large infarcts) on MT outcomes, has also revealed better clinical outcomes and lower risk of death inpatients 75) years of age[ 11 ]. When comparing our two ASPECTS tiers (0–5 vs 6–10), there was no significant difference in rates of successful recanalization (mTICI scores > 2b). Yet, 90-day functional outcomes in low-scoring patients were better if vessel recanalization was achieved. In MT-treated patients with low ASPECTS values (0–5), Kaesmacher et al have similarly linked successful recanalization to better outcomes and safety profiles [ 10 ]. Results of a meta-analysis by Cagnazzo et al also suggest that patients with ASPECTS values of 0–6 may benefit from MT, with successful recanalization not only heightening the probability of long-term functional improvement but also reducing sICH occurrences. Still, only about one of four patients with ASPECTS values of 4 retained functional independence after MT, and just 14% had favorable functional outcomes at ASPECTS values of 0–3 [ 9 ]. Above findings are compatible with ours, rates of functional independence, sICH, and mortality for the two ASPECTS tiers (0–5 vs 6–10) being significantly different. ASPECTS determinations ≤ 5 also strongly signaled worse 90-day clinical outcomes in our multivariable logistic regression model (Table 4 ).Ultimately, ASPECTS status is a measure of infarct size, an apparent correlate of functional outcomes after endovascular reperfusion therapy [ 13 , 14 ]. At lower scores, patients simply have less salvageable volumes of brain tissue and larger infarct volumes, both for shadowing functional deficits. Until now, identifying patients who might benefit most from endovascular therapy after strokes has remained a serious question. According to our data, younger age, lower baseline NIHSS score, lower HbA1c concentration, and successful recanalization are all independent predictors of favorable outcomes after MT, regardless of ASPECTS status. These parameters are also aligned with reported findings in a series of endovascular therapy recipients [ 11 , 15 – 19 ]. For a variety of reasons, we did not examine diffusion-weighted imaging (DWI) or computed tomography angiography (CTA) studies in this cohort. NCCT remains the most accessible and economical diagnostic tool for emergency use in patients with strokes, and it is often all that time allows. Moreover, symptom severity or existing contraindications may prohibit DWI or CTA scanning procedures. There are several limitations of this study worth mentioning. First, this was a single-center endeavor, with a relatively sparse sampling of low-scoring patients (ASPECTS 0–5) that may have skewed the results. In addition, all ASPECTS determinations were based entirely on NCCT images; and given the scarcity of patients with the lowest of scores (ASPECTS 0–3), comparative analysis within the lower ASPECTS tier (4–5 vs 0–3) was not feasible. Whether the lowest-scoring patients (0–3) actually benefit from MT remains a topic for further study. The findings provided herein must be corroborated as well by multicenter prospective studies that entail other methods of examination. Conclusion ASPECTS values ≤ 5 signal worse long-term functional status (mRS scores > 2) in patients with ACLVO-related AIS undergoing MT. Older age, elevated HbA1c concentration, and higher baseline NIHSS score are other independent risk factors for poor clinical outcomes, whereas successful recanalization is protective of functional independence. Abbreviations MT mechanical thrombectomy AIS acute ischemic strokes ACLVO anterior circulation large vessel occlusion NCCT non-contrast computed tomography ASPECTS Alberta Stroke Program Early Computed Tomography Score mRS modified Rankin Scale sICH symptomatic intracranial hemorrhage mTICI modified Thrombolysis in Cerebral Infarction NIHSS National Institute of Health Stroke Scale ICA internal carotid artery MCA middle cerebral artery CTA computed tomography angiography DSA digital subtraction angiography DBP diastolic blood pressure SBP systolic blood pressure HMCAS hyperdense middle cerebral artery sign tPA tissue plasminogen activator TOAST trial of ORG 10172 in acute stroke treatment Declaration Statement of Ethics The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The Local Ethics Committee [the Institutional Review Board of the General Hospital of the Northern Theater Command] approved the study protocol and provided the reference number (Approval Number Y (2020) 012). Because the study was retrospective, the General Hospital of the Northern Theater Command Institutional Review Board does not require written informed consent. Consent for publication Not Applicable. Data Availability Statement The datasets generated and/or analysed during the current study are not publicly available due [REASON WHY DATA ARE NOT PUBLIC] but are available from the corresponding author on reasonable request. Conflict of Interest Statement The authors have no conflicts of interest to declare. Funding Sources This work was supported by Project of Natural Science Foundation of Shenyang (grant no.20-205-4-044), Project of Natural Science Foundation of Liaoning Province (grant no.201602768) and Key Research and the Development Program of Liaoning Province, China (grant no.2020JH2/10300119). Author Contributions JL and YD: the conception and design of the study. JL and JD: acquisition of data. JC, JL and LZ: analysis and interpretation of data. JL and YD: drafting the article or revising it critically for important intellectual content. YD and BY: final approval of the version to be submitted. Acknowledgement We thank Qiuxiao Li for help in collecting clinical data. References Barber, P.A., et al., Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. The Lancet, 2000. 355 (9216): p. 1670-1674. Arne Potreck , A.F., Fatih Seker, Charlotte S Weyland, Sibu Mundiyanapurath, Sabine Heiland, Martin Bendszus and Johannes AR Pfaff, Accuracy and reliability of PBV ASPECTS, CBV ASPECTS and NCCT ASPECTS in acute ischaemic stroke a matched-pair analysis. The neuroradiology journal, 2021. 0 (0): p. 1-8. Yoo, A.J., et al., Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN). The Lancet Neurology, 2016. 15 (7): p. 685-694. Powers, W.J., et al., 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2018. 49 (3): p. e46-e110. Eskey, C.J., et al., Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation, 2018. 137 (21): p. e661-e689. Berkhemer, O.A., et al., A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 2015. 372 (1): p. 11-20. Albers, G.W., et al., Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med, 2018. 378 (8): p. 708-718. Phan, K., et al., Influence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis. Journal of NeuroInterventional Surgery, 2019. 11 (7): p. 664-669. Cagnazzo, F., et al., Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS </=6: a meta-analysis. J Neurointerv Surg, 2020. 12 (4): p. 350-355. Kaesmacher, J., et al., Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke, 2019. 50 (4): p. 880-888. Zaidat, O.O., et al., Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry. Stroke, 2021. 52 (7): p. 2220-2228. Goyal, N., et al., A multicenter study of the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke not meeting top-tier evidence criteria. J Neurointerv Surg, 2018. 10 (1): p. 10-16. Yoo, A.J., et al., MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke, 2009. 40 (6): p. 2046-54. Olivot, J.M., et al., Impact of diffusion-weighted imaging lesion volume on the success of endovascular reperfusion therapy. Stroke, 2013. 44 (8): p. 2205-11. Goyal, N., et al., Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy. J Neurointerv Surg, 2018. 10 (2): p. 112-117. Tonetti, D.A., et al., Successful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy. J Neurointerv Surg, 2020. 12 (6): p. 548-551. Diprose, W.K., et al., Glycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke. J Neurointerv Surg, 2020. 12 (1): p. 30-32. Khan, M.A., et al., Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort. J Neurointerv Surg, 2017. 9 (8): p. 727-731. Nogueira, R.G., et al., Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials. Stroke, 2009. 40 (12): p. 3777-83. Tables Table 1. Baseline patient characteristics, overall and by ASPECTS determinations Characteristic Overall (N=327) ASPECTS0-5 (n=43) ASPECTS 6-10 (n=284) P -value Age, y 63.6±12.5 60.4±10.8 64.1±12.7 0.026 Female 96 (29.3) 7 (16.3) 89 (31.3) 0.044 Hypertension 189 (57.6) 26 (60.5) 163 (57.4) 0.704 Diabetes mellitus 89 (27.1) 10 (23.3) 79 (27.8) 0.532 Hyperlipidemia 100 (30.5) 18 (41.9) 82 (28.9) 0.085 Atrial fibrillation/flutter 125 (38.1) 18 (41.9) 107 (37.7) 0.599 Coronary artery disease 64 (19.5) 7 (16.3) 57 (20.1) 0.560 Current/prior tobacco use 164 (50.0) 24 (55.8) 140 (49.3) 0426 Current/prior alcohol intake 158 (48.2) 24 (55.8) 134 (47.2) 0.292 TOAST classification 8 (2.4) 0.242 Large artery atherosclerosis 248 (75.6) 36 (83.7) 212 (74.6) Cardioembolism 71 (21.6) 5 (11.6) 66 (23.2) Other determined etiology 8 (2.4) 2 (4.7) 6 (2.1) Prestroke 67 (20.4) 6 (14.0) 61 (21.5) 0.255 Baseline NIHSS 15.2±4.5 18.1±5.2 14.7±4.2 < 0.001 HMCAS 204 (62.2) 33 (76.7) 171 (60.2) 0.037 Signs of early infarction 208 (63.4) 40 (93.0) 168 (59.2) < 0.001 DBP on admission, mmHg 141.1±25.2 135.8±27.7 141.8±24.6 0.070 SBP on admission, mmHg 83.0±15.1 82.9±14.7 83.1±15.3 0.879 HbA1c, mmol/L 7.5±3.4 8.8±5.8 7.2±2.8 0.189 D-dimer, mmol/L 2.6±4.1 2.8±3.1 2.6±4.3 0.066 Occlusive location 0.273 ICA 85 (25.9) 14 (32.6) 71 (25.0) MCA M1 142 (43.3) 18 (41.9) 124 (43.7) MCA M2 21 (6.4) 0 (0.0) 21 (7.4) ICA+MCA 79 (24.1) 11 (25.6) 68 (23.9) IV tPA 81 (24.7) 7 (16.3) 74 (26.1) 0.167 Oneset to puncture, min 499.5±392.3 468.4±244.5 504.3±410.3 0.627 Device passes 1.7±0.9 1.8±0.9 1.6±0.8 0.198 Balloon-guided catheter 78 (23.8) 9 (20.9) 69 (24.3) 0.630 Angioplasty and stenting 24 (7.3) 3 (7.0) 21 (7.4) 0.922 Significant values in bold Data expressed as n (%) or mean ± standard devation values *ASPECTS, Alberta Stroke Program Early CT Score; TOAST, Trial of Org 10172 in Acute Stroke Treatment; NIHSS, National Institutes of Health Stroke Scale; HMCAS, hyperdense middle cerebral artery sign; DBP, diastolic blood pressure; SBP, systolic blood pressure; HbA1c, glycosylated hemoglobin; ICA, internal carotid artery; MCA, middle cerebral artery; IV tPA, intravenous tissue plasminogen activator Table 2. Clinical outcomes of patients, overall and by ASPECTS determinations Outcomes Overall (N=327) ASPECTS0-5(n=43) ASPECTS6-10(n=284) P -value mTICI score 0 25 (7.6) 7 (16.3) 18 (6.3) 0.001 1 24 (7.3) 2 (4.7) 22 (7.7) 0.469 2a 33 (10.1) 1 (2.3) 32 (11.3) 0.070 2b 106 (32.3) 31 (72.1) 75 (26.4) 0.001 3 139 (42.4) 2 (4.7) 137 (48.2) 0.001 Successful reperfusion 245 (74.7) 33 (76.7) 212 (74.6) 0.768 Symptomatic ICH 79 (24.1) 17 (39.5) 62 (21.8) 0.012 Good functional outcomes (mRS score<2) at 90 days 154 (47.0) 14 (32.6) 140 (49.3) 0.041 90-day mRS score 3.0±1.3 3.5±1.5 2.9±1.3 0.043 Mortality 33 (10.1) 8 (18.6) 25 (8.8) 0.047 Significant values in bold Data expressed as n (%) or mean±standard devation values *ASPECTS, Alberta Stroke Program Early CT Score; mTICI, modified Thrombolysis in Cerebral Infarction; mRS, modified Rankin Scale; ICH, intracranial hemorrhage Table 3. Predictors of functional outcome at 90 days (univariate ordinal regression) Characteristic OR 95%CI P -value Age, y 1.07 1.05-1.09 < 0.001 Female 1.45 0.90-2.35 0.132 Hypertension 1.22 0.79-1.90 0.369 Diabetes mellitus 2.45 1.47-4.10 < 0.001 Hyperlipidemia 0.80 0.50-1.28 0.348 Atrial fibrillation/flutter 1.77 1.13-2.79 0.014 Coronary artery disease 1.63 0.93-2.85 0.088 Current/prior tobacco use 0.68 0.44-1.06 0.086 Current/prior alcohol intake 0.62 0.40-0.97 0.034 TOAST classification 0.82 0.53-1.27 0.368 Large artery atherosclerosis Cardioembolism Other determined etiology Prestroke 1.53 088-2.65 0.129 Baseline NIHSS score 1.14 1.07-1.20 < 0.001 HMCAS 0.90 0.58-1.42 0.060 Signs of early infarction 1.53 0.97-2.40 0.068 DBP on admission 1.00 0.99-1.00 0.310 SBP on admission 1.00 0.97-1.00 0.091 HbA1c 1.51 1.29-1.77 < 0.001 D-dimer 1.15 1.04-1.27 0.006 Occlusive location ICA 2.21 1.32-3.71 0.003 MCA M1 0.81 0.53-1.26 0.357 MCA M2 1.20 0.49-2.93 0.688 ICA+MCA 0.55 0.33-0.92 0.024 IV tPA 1.01 0.61-1.67 0.970 Oneset to puncture, min 0.99 0.99-1.00 0.056 Device passes 1.47 1.13-1.93 0.005 Balloon-guided catheter 0.75 0.45-1.25 0.268 Angioplasty and stenting 1.86 0.77-4.48 0.166 Successful reperfusion 0.34 0.20-0.58 < 0.001 Symptomatic ICH 1.63 0.97-2.74 0.063 ASPECTS≤5 2.01 1.02-3.97 0.043 Significant values in bold *TOAST, Trial of Org 10172 in Acute Stroke Treatment; NIHSS, National Institutes of Health Stroke Scale; HMCAS, hyperdense middle cerebral artery sign; DBP, diastolic blood pressure; SBP, systolic blood pressure; HbA1c, glycosylated hemoglobin; ICA, internal carotid artery; MCA, middle cerebral artery; IV tPA, intravenous tissue plasminogen activator; ASPECTS, Alberta Stroke Program Early CT Score Table 4. Multivariate logistic regression model of functional independence (mRS score 0-2 at 90d) Predictor Odds ratio 95%CI P -value ASPECTS≤5 1.40 1.00-5.80 0.049 Age 1.09 1.06-1.12 < 0.001 HbA1c 1.43 1.17-1.73 < 0.001 Baseline NIHSS 1.12 1.04-1.21 0.002 Successful reperfusion 0.32 0.15-0.66 0.002 Significant values in bold *ASPECTS, Alberta Stroke Program Early CT Score; HbA1c, glycosylated hemoglobin; NIHSS, National Institutes of Health Stroke Scale Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2067919","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":138694792,"identity":"faab0351-07f5-4376-8150-458ddfe8f793","order_by":0,"name":"Jinze Li","email":"","orcid":"","institution":"Jinzhou Medical University General Hospital of Northern Theater Command Postgraduate Training Base","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jinze","middleName":"","lastName":"Li","suffix":""},{"id":138694793,"identity":"15904506-e6e5-4321-a815-d3b59b12d773","order_by":1,"name":"Jinfeng Duan","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jinfeng","middleName":"","lastName":"Duan","suffix":""},{"id":138694794,"identity":"beae690b-3c00-4215-bdf4-6cb541be8d99","order_by":2,"name":"Luojin Zhang","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Luojin","middleName":"","lastName":"Zhang","suffix":""},{"id":138694795,"identity":"1736c37b-a0e9-4442-b7b2-19bb08a0cc96","order_by":3,"name":"Jingshu Chen","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jingshu","middleName":"","lastName":"Chen","suffix":""},{"id":138694796,"identity":"070ceb90-10c2-45e9-93a4-592444f0f284","order_by":4,"name":"yang Duan","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"yang","middleName":"","lastName":"Duan","suffix":""},{"id":138694797,"identity":"55dcddbf-58bd-4f76-8631-e93543ed3d4e","order_by":5,"name":"Benqiang Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACAwhlI8fP3sBwgBQtacaSPQdI03I4ccONBCIdZs6eY/i54BfQlpnPHx4uqGGQ5xcjYJllzxtj6Zl9QL9I5xgcnnGMwXDmbALWGdzIMZDm7QHaMjuH4TAPG0OCwW3CWox/8/YA/XLz+IPDPP+I02ImzfMD5H0Gg8O8bURosex5VmbN2wAKZKBfePskCPvFnD15822eP6CoPP74M883G3l+aQJaGBgyDBgY2+A8CULKQSD9AQPDH2IUjoJRMApGwYgFAOI3R3aVhl4XAAAAAElFTkSuQmCC","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Benqiang","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2022-09-15 08:44:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2067919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2067919/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27025422,"identity":"a48f6475-fde4-45db-badd-2515e32406ba","added_by":"auto","created_at":"2022-09-27 13:51:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25264,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic of patient selection.\u003c/p\u003e","description":"","filename":"FIGURE1.png","url":"https://assets-eu.researchsquare.com/files/rs-2067919/v1/d60347c39f70979e84ca8ff1.png"},{"id":27025424,"identity":"335fd264-178f-4ed8-9ce9-5e5ff5f9695e","added_by":"auto","created_at":"2022-09-27 13:51:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":750835,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative images of patients in ASPECTS tiers:\u003c/p\u003e\n\u003cp\u003e(A-C) 56 year-old man with baseline ASPECTS of 6 (M1, M2, L, M6); baseline NIHSS score, 11; HbA1c, 9.22; mTICI score, 2b; and mRS score, 2.\u003c/p\u003e\n\u003cp\u003e(D-F) 77 year-old woman with baseline ASPECTS of 4(M2, I, L, IC, M5, M6); baseline NIHSS score, 20; HbA1c, 5.38; mTICI score, 2b; and mRS score, 3.\u003c/p\u003e\n\u003cp\u003eMiddle cerebral artery (MCA), insula (I), lenticular nucleus (L), caudate nucleus (C), posterior limb of internal capsule (IC)\u003c/p\u003e","description":"","filename":"FIGURE2.png","url":"https://assets-eu.researchsquare.com/files/rs-2067919/v1/cda7455797968a8f5634b62a.png"},{"id":27025682,"identity":"afe5b955-64ec-404a-a607-48e9acb7de97","added_by":"auto","created_at":"2022-09-27 13:56:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":18439,"visible":true,"origin":"","legend":"\u003cp\u003eFunctional outcomes (modified Rankin Scale [mRS]) at 90 days for two tiers of Alberta Stroke Program Early CT Score (ASPECTS).\u003c/p\u003e","description":"","filename":"FIGURE3.png","url":"https://assets-eu.researchsquare.com/files/rs-2067919/v1/54ab53367467edc9ff722855.png"},{"id":33580911,"identity":"0e231e80-bfe2-4575-b1f2-1a5628876ece","added_by":"auto","created_at":"2023-02-28 19:59:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":739109,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2067919/v1/b87a7b85-1e62-4466-be31-bc0fa1f0fff1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Low (0-5) Alberta Stroke Program Early Computed Tomography Score on Admission Predictive of Worse Functional Outcome after Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDomestic and foreign studies have validated the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as a standardized quantitative metric, reflecting the extent of infarction in instances of acute anterior circulation large vessel occlusion (ACLVO) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Recent reports have also demonstrated that this simple and reliable measure may serve to identify the most suitable patients for endovascular therapy and function as a prognostic index [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to American Heart Association/American Stroke Association guidelines, the standard of care in adult patients with ASPECTS values\u0026thinsp;\u0026ge;\u0026thinsp;6 and large-vessel occlusion is endovascular therapy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, much of the research on mechanical thrombectomy (MT) has excluded patients with lower ASPECTS values (\u0026le;\u0026thinsp;6 or 7), failing to fully address the prognostic utility of ASPECTS in MT-treated patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, we compared ASPECTS values of NCCT studies on admission with clinical consequences of MT (including successful recanalization, functional improvement, symptomatic intracranial hemorrhage [sICH], and mortality), hoping to facilitate the planning of MT procedures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a single-center retrospective observational analysis of 327 consecutive patients with ACLVO-related AIS treated by MT between January 2016 and August 2022. The hospital\u0026apos;s institutional review board approved our study protocol.\u003c/p\u003e\n\u003cp\u003eEligible MT-treated subjects met the following inclusion criteria: (1) adult \u0026ge;18 years; (2) availability of non-contrast computed tomography (NCCT) imaging done on admission; and (3) proximal anterior circulation occlusion involving internal carotid artery (ICA) or M1/proximal M2 branch of middle cerebral artery (MCA), as shown by computed tomography angiography (CTA) or digital subtraction angiography (DSA). The following were grounds for study exclusion: (1) prior severe stroke, with baseline National Institutes of Health Stroke Scale (NIHSS) score\u0026le;8 or baseline modified Rankin Scale (mRS) score\u0026ge;1; (2) farction on baseline CT; or (3) other brain abnormalities, such as tumors or trauma (shown in Fig. 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe retrieved baseline patient characteristics (age and sex), medical history (including prior stroke, coronary artery disease, atrial fibrillation/flutter, hypertension, hyperlipidemia, or diabetes mellitus), and lifestyle habits (current/prior tobacco use, alcohol intake), as well as clinical parameters on admission (ie, NIHSS score, diastolic [DBP] and systolic [SBP] blood pressure readings, glycosylated hemoglobin [HbA1c] concentration, D-dimer level, and presence of hyperdense middle cerebral artery sign [HMCAS] or signs of early infarction on NCCT) and intravenous injection of tissue plasminogen activator (tPA) from electronic medical records. Other clinical variables, including trial of ORG 10172 in acute stroke treatment (TOAST) classification, occlusive location, stroke-onset to puncture time, number of device passes, and use of balloon-guided catheter or angioplasty/stenting, were also recorded.\u003c/p\u003e\n\u003cp\u003eAll NCCT studies were performed by Discovery CT 750 HD scanner (GE Healthcare, Chicago, IL, USA) at the following settings: tube voltage, 100 kV; tube current, 120 mA; collimator width, 40mm; field of view, 25cm; layer thickness, 5mm; layer spacing, 5mm. Two neuroradiologists blinded to clinical outcomes separately determined ASPECTS values for each patient. Inconsistencies were resolved by imaging reviews, reaching consensus decisions through discussion.\u003c/p\u003e\n\u003cp\u003eIn ASPECTS determinations, MCA vascular supply has 10 defined territories\u0026nbsp;[1], including seven regions of caudate nucleus and layers below (M1, M2, M3, insula [I], lenticular nucleus[L], caudate nucleus [C], and posterior limb of internal capsule [IC]) and three areas of cerebral cortex above the nucleus(M4, M5, and M6). Maximum score is 10 points, subtracting 1 point for each injured area (shown in Fig.\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary study endpoint was long-term functional independence, measured by mRS at 90 days. Secondary endpoints were successful vascular reperfusion immediately following MT (ie, modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b or 3); symptomatic intracranial hemorrhage (sICH), indicated by\u0026ge;4-point decline in NIHSS score or CT evidence of hemorrhage within 24 hours post-MT; and mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll computations were driven by standard software (SPSS v22.6; IBM Corp, Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. The Shapiro-Wilk test was applied to determine normality of distributions. Continuous variables with non-normal distributions were expressed as mean \u0026plusmn; standard deviation (SD) or median (interquartile range [IQR]) values. Normally distributed continuous variables were subjected to Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test, assesssing non-normal variables by Mann-Whitney \u003cem\u003eU\u0026nbsp;\u003c/em\u003etest and categorical variables by Fisher\u0026rsquo;s exact or \u0026chi;2 test. Multivariate logistic regression analysis served to identify independent predictors of clinical outcomes. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), setting significance at \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv\u003e\n \u003ch2\u003eBaseline patient characteristics\u003c/h2\u003e\n \u003cp\u003eThe 327 qualifying patients were grouped according to ASPECTS tier (0\u0026ndash;5, 43; 6\u0026ndash;10, 284). Mean age was 63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5 years, and 96 (29.3%) were women. A summary of group parameters is provided in Table 1. Members of the low-scoring (0\u0026ndash;5) group exhibited more extreme presentations than did high-scoring (6\u0026ndash;10) group members (mean baseline NIHSS score: 18.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 vs 14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Likewise, HMCAS positivity (76.7% vs 60.2%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037) and signs of early infarction (93.0% vs 59.2%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly more prevalent in the low-scoring (vs high-scoring) group.\u003c/p\u003e\u0026nbsp; \u003cstrong\u003eClinical outcomes\u003c/strong\u003e\n \u003cp\u003eClinical outcomes are shown by group in \u003cstrong\u003eTable 2\u003c/strong\u003e. Unlike the high (6-10) ASPECTS tier, low-tier (0-5) members were less inclined to show good clinical outcomes (mRS scores 0-2) at 90 days (32.6% vs 49.3%; \u003cem\u003ep\u003c/em\u003e=0.041) (shown in Fig. 3), demonstrating higher rates of sICH (39.5% vs 21.8%; \u003cem\u003ep\u003c/em\u003e=0.012) and mortality (18.6% vs 8.8%; \u003cem\u003ep\u003c/em\u003e=0.047). However, successful reperfusion rates did not differ significantly in the two groups (76.7% vs 74.6%; \u003cem\u003ep\u003c/em\u003e=0.0768).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Predictors of worse functional outcomes (mRS scores \u0026gt;2)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003econtains a listing of unfavorable prognosticators, including older age (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), higher baseline NIHSS score (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), histories of diabetes mellitus (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) or atrial fibrillation/flutter (\u003cem\u003ep\u003c/em\u003e=0.014), current/prior alcohol intake(\u003cem\u003ep\u003c/em\u003e=0.034), increased HbA1c concentration (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), elevated D-dimer level (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), occlusion of ICA (\u003cem\u003ep\u003c/em\u003e=0.003), non-occlusion of ICA+MCA (\u003cem\u003ep\u003c/em\u003e=0.024), number of device passes(\u003cem\u003ep\u003c/em\u003e=0.024), successful reperfusion (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and initial ASPECTS value \u0026le;5 (\u003cem\u003ep\u003c/em\u003e=0.043).\u003c/p\u003e\n \u003cp\u003eIn multivariate logistic regression, a relation between ASPECTS of \u0026le; 5 and worse functional outcome (mRS score \u0026gt;2) at 90 days (OR=1.40, 95% CI: 1.00-5.80; \u003cem\u003ep\u003c/em\u003e=0.049) emerged, once adjusted for age, NIHSS score, diabetes mellitus, atrial fibrillation/flutter, current/prior alcohol intake, HbA1c concentration, D-dimer level, occlusion of ICA, occlusion of ICA+MCA, number of device passes, and successful reperfusion (\u003cstrong\u003eTable4\u003c/strong\u003e).\u003c/p\u003e\n \n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Discussion/Conclusion should provide an evaluation of the results. There should be a clear discussion of the implications, significance, and novelty of the results presented and whether the data support or contradict previous studies.\u003c/p\u003e \u003cp\u003ePresent findings indicate that ASPECTS values\u0026thinsp;\u0026le;\u0026thinsp;5 on admission NCCT studies reduce the likelihood of long-term functional independence and increase the odds of sICH and mortality after MT in patients with ACLVO-related AIS. On the other hand, higher ASPECTS values (6\u0026ndash;10) herald significantly better clinical outcomes and carry less risk of death. These associations proved significant in multivariate regression analysis, with other independent predictors emerging as well.\u003c/p\u003e \u003cp\u003eASPECTS is a simple and convenient, topographic method of semiquantitatively gauging early ischemic core infarct volume and is deemed strongly predictive of clinical outcomes in the setting of AIS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Typically, it is a stipulation for enrollment in various randomized intravascular treatment trials. Because past efforts seemed to restrict the merits of MT to patients with ASPECTS values\u0026thinsp;\u0026ge;\u0026thinsp;6, subsequent clinical trials have tended to exclude those with lesser scores [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Indeed, a recent meta-analysis of such studies undertaken by Phan et al to explore ASPECTS as a basis for revascularization suitability has demonstrated the prognostic favorability of a higher (vs lower) ASPECTS status in the course of endovascular thrombectomy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, more and more efforts are showing that patients with lower ASPECTS values may well benefit from MT under certain conditions [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a subgroup analysis of the MR CLEAN randomized phase 3 trial, patients with ASPECTS values of 5\u0026ndash;7 were regarded as acceptable candidates for endovascular therapy, otherwise weighing potential treatment benefit and cost-effectiveness of endovascular therapy (in conjunction with various influential factors) at values of 0\u0026ndash;4 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. An analysis from the STRATIS Registry, conducted by Zaidat et al and aimed at impacts of age and low (0\u0026ndash;5) ASPECTS status (ie, large infarcts) on MT outcomes, has also revealed better clinical outcomes and lower risk of death inpatients\u0026thinsp;\u0026lt;\u0026thinsp;65 (vs\u0026thinsp;\u0026gt;\u0026thinsp;75) years of age[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen comparing our two ASPECTS tiers (0\u0026ndash;5 vs 6\u0026ndash;10), there was no significant difference in rates of successful recanalization (mTICI scores\u0026thinsp;\u0026gt;\u0026thinsp;2b). Yet, 90-day functional outcomes in low-scoring patients were better if vessel recanalization was achieved. In MT-treated patients with low ASPECTS values (0\u0026ndash;5), Kaesmacher et al have similarly linked successful recanalization to better outcomes and safety profiles [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Results of a meta-analysis by Cagnazzo et al also suggest that patients with ASPECTS values of 0\u0026ndash;6 may benefit from MT, with successful recanalization not only heightening the probability of long-term functional improvement but also reducing sICH occurrences. Still, only about one of four patients with ASPECTS values of 4 retained functional independence after MT, and just 14% had favorable functional outcomes at ASPECTS values of 0\u0026ndash;3 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAbove findings are compatible with ours, rates of functional independence, sICH, and mortality for the two ASPECTS tiers (0\u0026ndash;5 vs 6\u0026ndash;10) being significantly different. ASPECTS determinations\u0026thinsp;\u0026le;\u0026thinsp;5 also strongly signaled worse 90-day clinical outcomes in our multivariable logistic regression model (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).Ultimately, ASPECTS status is a measure of infarct size, an apparent correlate of functional outcomes after endovascular reperfusion therapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. At lower scores, patients simply have less salvageable volumes of brain tissue and larger infarct volumes, both for shadowing functional deficits.\u003c/p\u003e \u003cp\u003eUntil now, identifying patients who might benefit most from endovascular therapy after strokes has remained a serious question. According to our data, younger age, lower baseline NIHSS score, lower HbA1c concentration, and successful recanalization are all independent predictors of favorable outcomes after MT, regardless of ASPECTS status. These parameters are also aligned with reported findings in a series of endovascular therapy recipients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor a variety of reasons, we did not examine diffusion-weighted imaging (DWI) or computed tomography angiography (CTA) studies in this cohort. NCCT remains the most accessible and economical diagnostic tool for emergency use in patients with strokes, and it is often all that time allows. Moreover, symptom severity or existing contraindications may prohibit DWI or CTA scanning procedures.\u003c/p\u003e \u003cp\u003eThere are several limitations of this study worth mentioning. First, this was a single-center endeavor, with a relatively sparse sampling of low-scoring patients (ASPECTS 0\u0026ndash;5) that may have skewed the results. In addition, all ASPECTS determinations were based entirely on NCCT images; and given the scarcity of patients with the lowest of scores (ASPECTS 0\u0026ndash;3), comparative analysis within the lower ASPECTS tier (4\u0026ndash;5 vs 0\u0026ndash;3) was not feasible. Whether the lowest-scoring patients (0\u0026ndash;3) actually benefit from MT remains a topic for further study. The findings provided herein must be corroborated as well by multicenter prospective studies that entail other methods of examination.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eASPECTS values\u0026thinsp;\u0026le;\u0026thinsp;5 signal worse long-term functional status (mRS scores\u0026thinsp;\u0026gt;\u0026thinsp;2) in patients with ACLVO-related AIS undergoing MT. Older age, elevated HbA1c concentration, and higher baseline NIHSS score are other independent risk factors for poor clinical outcomes, whereas successful recanalization is protective of functional independence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" id=\"Taba\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emechanical thrombectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eacute ischemic strokes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACLVO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eanterior circulation large vessel occlusion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNCCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enon-contrast computed tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASPECTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlberta Stroke Program Early Computed Tomography Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emodified Rankin Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esymptomatic intracranial hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emTICI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emodified Thrombolysis in Cerebral Infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNIHSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNational Institute of Health Stroke Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003einternal carotid artery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emiddle cerebral artery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecomputed tomography angiography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edigital subtraction angiography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ediastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHMCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehyperdense middle cerebral artery sign\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etissue plasminogen activator\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTOAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etrial of ORG 10172 in acute stroke treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec13\"\u003e\n \u003ch2\u003e\u003cbr\u003e\u003c/h2\u003e\n\u003c/div\u003e\n"},{"header":"Declaration","content":"\u003cp\u003e\u003cstrong\u003eStatement of Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The Local Ethics Committee [the Institutional Review Board of the General Hospital of the Northern Theater Command] approved the study protocol and provided the reference number (Approval Number Y (2020) 012).\u003c/p\u003e\n\u003cp\u003eBecause the study was retrospective, the General Hospital of the Northern Theater Command Institutional Review Board does not require written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due [REASON WHY DATA ARE NOT PUBLIC] but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Project of Natural Science Foundation of Shenyang (grant no.20-205-4-044), Project of Natural Science Foundation of Liaoning Province (grant no.201602768) and Key Research and the Development Program of Liaoning Province, China (grant no.2020JH2/10300119).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJL and YD: the conception and design of the study. JL and JD: acquisition of data. JC, JL and LZ: analysis and interpretation of data. JL and YD: drafting the article or revising it critically for important intellectual content. YD and BY: final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Qiuxiao Li for help in collecting clinical data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBarber, P.A., et al., \u003cem\u003eValidity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy.\u003c/em\u003e The Lancet, 2000. \u003cstrong\u003e355\u003c/strong\u003e(9216): p. 1670-1674.\u003c/li\u003e\n\u003cli\u003eArne Potreck , A.F., Fatih Seker, Charlotte S Weyland, Sibu Mundiyanapurath, Sabine Heiland, Martin Bendszus and Johannes AR Pfaff, \u003cem\u003eAccuracy and reliability of PBV ASPECTS, CBV ASPECTS and NCCT ASPECTS in acute ischaemic stroke a matched-pair analysis.\u003c/em\u003e The neuroradiology journal, 2021. \u003cstrong\u003e0\u003c/strong\u003e(0): p. 1-8.\u003c/li\u003e\n\u003cli\u003eYoo, A.J., et al., \u003cem\u003eEffect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN).\u003c/em\u003e The Lancet Neurology, 2016. \u003cstrong\u003e15\u003c/strong\u003e(7): p. 685-694.\u003c/li\u003e\n\u003cli\u003ePowers, W.J., et al., \u003cem\u003e2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.\u003c/em\u003e Stroke, 2018. \u003cstrong\u003e49\u003c/strong\u003e(3): p. e46-e110.\u003c/li\u003e\n\u003cli\u003eEskey, C.J., et al., \u003cem\u003eIndications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association.\u003c/em\u003e Circulation, 2018. \u003cstrong\u003e137\u003c/strong\u003e(21): p. e661-e689.\u003c/li\u003e\n\u003cli\u003eBerkhemer, O.A., et al., \u003cem\u003eA randomized trial of intraarterial treatment for acute ischemic stroke.\u003c/em\u003e N Engl J Med, 2015. \u003cstrong\u003e372\u003c/strong\u003e(1): p. 11-20.\u003c/li\u003e\n\u003cli\u003eAlbers, G.W., et al., \u003cem\u003eThrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging.\u003c/em\u003e N Engl J Med, 2018. \u003cstrong\u003e378\u003c/strong\u003e(8): p. 708-718.\u003c/li\u003e\n\u003cli\u003ePhan, K., et al., \u003cem\u003eInfluence of ASPECTS and endovascular thrombectomy in acute ischemic stroke: a meta-analysis.\u003c/em\u003e Journal of NeuroInterventional Surgery, 2019. \u003cstrong\u003e11\u003c/strong\u003e(7): p. 664-669.\u003c/li\u003e\n\u003cli\u003eCagnazzo, F., et al., \u003cem\u003eMechanical thrombectomy in patients with acute ischemic stroke and ASPECTS \u0026lt;/=6: a meta-analysis.\u003c/em\u003e J Neurointerv Surg, 2020. \u003cstrong\u003e12\u003c/strong\u003e(4): p. 350-355.\u003c/li\u003e\n\u003cli\u003eKaesmacher, J., et al., \u003cem\u003eMechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5.\u003c/em\u003e Stroke, 2019. \u003cstrong\u003e50\u003c/strong\u003e(4): p. 880-888.\u003c/li\u003e\n\u003cli\u003eZaidat, O.O., et al., \u003cem\u003eImpact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry.\u003c/em\u003e Stroke, 2021. \u003cstrong\u003e52\u003c/strong\u003e(7): p. 2220-2228.\u003c/li\u003e\n\u003cli\u003eGoyal, N., et al., \u003cem\u003eA multicenter study of the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke not meeting top-tier evidence criteria.\u003c/em\u003e J Neurointerv Surg, 2018. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 10-16.\u003c/li\u003e\n\u003cli\u003eYoo, A.J., et al., \u003cem\u003eMRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization.\u003c/em\u003e Stroke, 2009. \u003cstrong\u003e40\u003c/strong\u003e(6): p. 2046-54.\u003c/li\u003e\n\u003cli\u003eOlivot, J.M., et al., \u003cem\u003eImpact of diffusion-weighted imaging lesion volume on the success of endovascular reperfusion therapy.\u003c/em\u003e Stroke, 2013. \u003cstrong\u003e44\u003c/strong\u003e(8): p. 2205-11.\u003c/li\u003e\n\u003cli\u003eGoyal, N., et al., \u003cem\u003eAdmission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy.\u003c/em\u003e J Neurointerv Surg, 2018. \u003cstrong\u003e10\u003c/strong\u003e(2): p. 112-117.\u003c/li\u003e\n\u003cli\u003eTonetti, D.A., et al., \u003cem\u003eSuccessful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy.\u003c/em\u003e J Neurointerv Surg, 2020. \u003cstrong\u003e12\u003c/strong\u003e(6): p. 548-551.\u003c/li\u003e\n\u003cli\u003eDiprose, W.K., et al., \u003cem\u003eGlycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke.\u003c/em\u003e J Neurointerv Surg, 2020. \u003cstrong\u003e12\u003c/strong\u003e(1): p. 30-32.\u003c/li\u003e\n\u003cli\u003eKhan, M.A., et al., \u003cem\u003eEndovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort.\u003c/em\u003e J Neurointerv Surg, 2017. \u003cstrong\u003e9\u003c/strong\u003e(8): p. 727-731.\u003c/li\u003e\n\u003cli\u003eNogueira, R.G., et al., \u003cem\u003ePredictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials.\u003c/em\u003e Stroke, 2009. \u003cstrong\u003e40\u003c/strong\u003e(12): p. 3777-83.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003eBaseline patient characteristics, overall and by ASPECTS determinations\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"117%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.37373737373738%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.171717171717173%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003cbr\u003e\u0026nbsp;(N=327)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e\u003cstrong\u003eASPECTS0-5 \u0026nbsp;(n=43)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eASPECTS 6-10 \u0026nbsp;(n=284)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eAge, y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e63.6\u0026plusmn;12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e60.4\u0026plusmn;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e64.1\u0026plusmn;12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e96 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e89 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e189 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e26 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e163 (57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e89 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e10 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e79 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e100 (30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e18 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e82 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eAtrial fibrillation/flutter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e125 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e18 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e107 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e64 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e57 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eCurrent/prior tobacco use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e164 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e24 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e140 (49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0426\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eCurrent/prior alcohol intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e158 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e24 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e134 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eTOAST classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e8 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eLarge artery atherosclerosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e248 (75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e36 (83.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e212 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eCardioembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e71 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e5 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e66 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eOther determined etiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e8 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e2 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e6 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003ePrestroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e67 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e6 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e61 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eBaseline NIHSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e15.2\u0026plusmn;4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e18.1\u0026plusmn;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e14.7\u0026plusmn;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026lt;\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eHMCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e204 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e33 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e171 (60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eSigns of early infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e208 (63.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e40 (93.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e168 (59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026lt;\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eDBP on admission, mmHg\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e141.1\u0026plusmn;25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e135.8\u0026plusmn;27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e141.8\u0026plusmn;24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eSBP on admission, mmHg\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e83.0\u0026plusmn;15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e82.9\u0026plusmn;14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e83.1\u0026plusmn;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.879\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eHbA1c, mmol/L\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e7.5\u0026plusmn;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e8.8\u0026plusmn;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e7.2\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eD-dimer, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e2.6\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e2.8\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e2.6\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eOcclusive location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eICA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e85 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e14 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e71 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eMCA M1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e142 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e18 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e124 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eMCA M2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e21 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e21 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eICA+MCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e79 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e11 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e68 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eIV tPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e81 (24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e74 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eOneset to puncture, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e499.5\u0026plusmn;392.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e468.4\u0026plusmn;244.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e504.3\u0026plusmn;410.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eDevice passes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e1.7\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e1.8\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e1.6\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eBalloon-guided catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e78 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e9 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e69 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.37373737373738%\"\u003e\n \u003cp\u003eAngioplasty and stenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e24 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.171717171717173%\"\u003e\n \u003cp\u003e3 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.181818181818183%\"\u003e\n \u003cp\u003e21 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.1010101010101%\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSignificant values in bold\u003c/p\u003e\n\u003cp\u003eData expressed as n (%) or mean \u0026plusmn; standard devation values\u003c/p\u003e\n\u003cp\u003e*ASPECTS, Alberta Stroke Program Early CT Score; TOAST, Trial of Org 10172 in Acute Stroke Treatment; NIHSS, National Institutes of Health Stroke Scale; HMCAS, hyperdense middle cerebral artery sign; DBP, diastolic blood pressure; SBP, systolic blood pressure; HbA1c, glycosylated hemoglobin; ICA, internal carotid artery; MCA, middle cerebral artery; IV tPA, intravenous tissue plasminogen activator\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2.\u003c/strong\u003eClinical outcomes of patients, overall and by ASPECTS determinations\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.5%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.018072289156628%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=327)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e\u003cstrong\u003eASPECTS0-5(n=43)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e\u003cstrong\u003eASPECTS6-10(n=284)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003emTICI score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e25 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e18 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e24 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e2 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e22 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e2a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e33 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e1 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e32 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e2b\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e106 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e31 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e75 (26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e139 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e2 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e137 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eSuccessful reperfusion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e245 (74.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e33 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e212 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eSymptomatic ICH\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e79 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e17 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e62 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eGood functional outcomes (mRS score\u0026lt;2) at 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e154 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e14 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e140 (49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e90-day mRS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e3.0\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e3.5\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e2.9\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e33 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.018072289156628%\"\u003e\n \u003cp\u003e8 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.22289156626506%\"\u003e\n \u003cp\u003e25 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.240963855421686%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSignificant values in bold\u003c/p\u003e\n\u003cp\u003eData expressed as n (%) or mean\u0026plusmn;standard devation values\u003c/p\u003e\n\u003cp\u003e*ASPECTS, Alberta Stroke Program Early CT Score; mTICI, modified Thrombolysis in Cerebral Infarction; mRS, modified Rankin Scale; ICH, intracranial hemorrhage\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3.\u003c/strong\u003ePredictors of functional outcome at 90 days (univariate ordinal regression)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"94%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eAge, y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.05-1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.90-2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.79-1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.47-4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.50-1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eAtrial fibrillation/flutter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.13-2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.93-2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eCurrent/prior tobacco use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.44-1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eCurrent/prior alcohol intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.40-0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eTOAST classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.53-1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eLarge artery atherosclerosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eCardioembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eOther determined etiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003ePrestroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e088-2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eBaseline NIHSS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.07-1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eHMCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.58-1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eSigns of early infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.97-2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eDBP on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.99-1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eSBP on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.97-1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eHbA1c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.29-1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eD-dimer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.04-1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eOcclusive location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eICA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.32-3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eMCA M1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.53-1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eMCA M2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.49-2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eICA+MCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.33-0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eIV tPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.61-1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eOneset to puncture, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.99-1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eDevice passes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.13-1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eBalloon-guided catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.45-1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eAngioplasty and stenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.77-4.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eSuccessful reperfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.20-0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eSymptomatic ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.97-2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003eASPECTS\u0026le;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e1.02-3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.21212121212121%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSignificant values in bold\u003c/p\u003e\n\u003cp\u003e*TOAST, Trial of Org 10172 in Acute Stroke Treatment; NIHSS, National Institutes of Health Stroke Scale; HMCAS, hyperdense middle cerebral artery sign; DBP, diastolic blood pressure; SBP, systolic blood pressure; HbA1c, glycosylated hemoglobin; ICA, internal carotid artery; MCA, middle cerebral artery; IV tPA, intravenous tissue plasminogen activator; ASPECTS, Alberta Stroke Program Early CT Score\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4.\u003c/strong\u003eMultivariate logistic regression model of functional independence (mRS score 0-2 at 90d)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.75373134328358%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.75373134328358%\"\u003e\n \u003cp\u003eASPECTS\u0026le;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.00-5.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.75373134328358%\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.06-1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.75373134328358%\"\u003e\n \u003cp\u003eHbA1c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.17-1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.75373134328358%\"\u003e\n \u003cp\u003eBaseline NIHSS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e1.04-1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"36.75373134328358%\"\u003e\n \u003cp\u003eSuccessful reperfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e0.15-0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.082089552238806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSignificant values in bold\u003c/p\u003e\n\u003cp\u003e*ASPECTS, Alberta Stroke Program Early CT Score; HbA1c, glycosylated hemoglobin; NIHSS, National Institutes of Health Stroke Scale\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"mechanical thrombectomy, stroke imaging, acute ischemic stroke, CT, outcomes","lastPublishedDoi":"10.21203/rs.3.rs-2067919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2067919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND AND PURPOSE\u003c/h2\u003e \u003cp\u003eWe examined functional outcomes of mechanical thrombectomy (MT) procedures following anterior circulation large vessel occlusion (ACLVO)-related acute ischemic strokes (AIS). Results were based on admission non-contrast computed tomography (NCCT) studies, using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as standard metric.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eQualifying subjects were consecutive patients (N\u0026thinsp;=\u0026thinsp;327) at a single center undergoing MT for ACLVO-related AIS. Each was grouped according to ASPECTS status on admission, determined from NCCT images by two physicians. Primary clinical endpoint was functional independence, assessed via modified Rankin Scale (mRS) at 90 days. Secondary endpoints were vessel recanalization (ie, modified Thrombolysis in Cerebral Infarction [mTICI] score), symptomatic intracranial hemorrhage (sICH), and mortality.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eIn this study population (mean age, 63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5 years; women, 29.3%; median baseline National Institute of Health Stroke Scale [NIHSS] score, 15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5), patients were stratified by ASPECTS tier at presentation, either 0\u0026ndash;5 (n\u0026thinsp;=\u0026thinsp;43) or 6\u0026ndash;10 (n\u0026thinsp;=\u0026thinsp;284). Multivariate logistic regression showed a relation between ASPECTS values\u0026thinsp;\u0026le;\u0026thinsp;5 and lesser chance of 90-day functional improvement (OR\u0026thinsp;=\u0026thinsp;1.40, 95% confidence interval [CI]: 1.00-5.80; p\u0026thinsp;=\u0026thinsp;0.049), once adjusted for age, baseline NIHSS score, diabetes mellitus, atrial fibrillation/flutter, current/prior alcohol intake, HbA1c concentration, D-dimer level, occlusion of internal carotid artery (ICA), occlusion of ICA and middle cerebral artery (ICA\u0026thinsp;+\u0026thinsp;MCA), numbers of device passes, and successful recanalization.\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e \u003cp\u003eASPECTS values\u0026thinsp;\u0026le;\u0026thinsp;5 correspond with worse long-term functional improvement (mRS scores\u0026thinsp;\u0026gt;\u0026thinsp;2) in patients undergoing MT for ACLVO-related AIS. Other independent determinants of functional outcomes after MT are age, baseline NIHSS score, HbA1c concentration, and successful recanalization.\u003c/p\u003e","manuscriptTitle":"Low (0-5) Alberta Stroke Program Early Computed Tomography Score on Admission Predictive of Worse Functional Outcome after Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-27 13:51:42","doi":"10.21203/rs.3.rs-2067919/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a05935c0-b452-4989-8b77-d17365893508","owner":[],"postedDate":"September 27th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-03-06T07:44:40+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-27 13:51:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2067919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2067919","identity":"rs-2067919","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}