Endovascular treatment of stroke in the late time window with large vessel occlusion using the ASPECTS as an imaging screening criterion

Objective: To assess the Alberta Stroke Program Early CT Score (ASPECTS) screening tool for effectiveness in endovascular treatment of late time window stroke with large vessel occlusion. Patients and methods A retrospective analysis was performed of individuals administered endovascular treatment in our neurology department between 2016 and 2020 for ischemic stroke induced by acute large vessel occlusion in the anterior circulation. Detailed baseline and endovascular treatment data were collected. Patients were assigned to 2 groups based on stroke onset time, including the 0-6h (treated within 6h of stroke onset) and 6-24h (earlier/unknown time of onset, up to 24 hours from the last time of appearing normal) groups. Both groups were compared for baseline information, revascularization rates, symptomatic intracranial hemorrhage, and 90-day functional independence. Results Totally 221 individuals were enrolled. The 0-6h and 6-24h groups had 129 and 92 patients, respectively, whose median ages were 64 and 63 years, respectively. Both groups were similar in previous medical history, NIHSS score at onset, lesion location and surgical complications. The 6-24h group had elevated intracranial atherosclerotic stenosis (48.9% vs 33.3%, P = 0.020) and revascularization (96.7% vs 86.8%, P = 0.011) rates versus the 6-24h group. Upon adjustment for age, sex, National Institutes of Health Stroke Scale, ASPECTS, Intracranial atherosclerosis, intraoperative tirofiban, stent detachment, successful recanalization, and symptomatic intracranial hemorrhage, the 0-6h group had a higher rate of individuals achieving functional independence (mRS score of 0–2; 52.7% vs 47.8%, OR = 0.242 [0.070–0.833], P = 0.024). However, the rates of individuals with a favorable outcome (mRS scores of 0–3) were similar in both groups (66.7% vs. 69.6%; OR = 0.564 [0.140–2.266], P = 0.419) as well as 90-d mortality (OR = 0.889 [0.170–4.660], P = 0.889). Conclusions The ASPECTS is effective for screening individuals for endovascular treatment of stroke in the late time window with large vessel occlusion. The ASPECTS should be considered a simple and practical patient screening strategy for stroke centers without multimodal imaging evaluation.