Objective:

This study aims to investigate factors contributing to lower Alberta Stroke Program Early CT Scores (ASPECTS) in follow-up imaging, despite initial high ASPECTS and successful mechanical thrombectomy in large vessel occlusion (LVO) stroke patients

Background:

Mechanical thrombectomy (MT) has become one of the leading strategies for managing acute ischemic stroke caused by LVO, significantly improving patient outcomes. The ASPECTS helps select MT candidates, and the extended Thrombolysis in Cerebral Infarction (eTICI) scale measures procedural success, with eTICI 2b or higher indicating success. However, some patients exhibit a lower ASPECTS in 24-hour follow-up imaging, raising questions about the factors behind this unexpected decline, despite successful MT

Design/Methods:

This retrospective study used prospectively collected data from the Society of Vascular and Interventional Neurology (SVIN) registry. We included LVO patients treated between January 2020 and December 2023. ASPECTS at admission and 24-hour follow-up were recorded, along with eTICI scores and other factors such as age, blood glucose, number of passes, collateral status, time from last known well (LKW) to recanalization, comorbidities, and post-thrombectomy follow-up. We defined ASPECTS-d as the difference between admission and 24-hour ASPECTS and used descriptive statistics and multivariable logistic regression to investigate predictors of higher ASPECTS-d

Results:

Of 394 patients, 287 had a ASPECTS-d >1, and 107 had ASPECTS-d = 0. Multivariable regression showed that longer LKW-to-recanalization time (OR 1.001, p=0.029) was significantly associated with higher ASPECTS-d, independently of age, IVT, AF, HTN, DM, and prior Aspirine. Higher number of passes showed a non-significant trend (OR 1.21, p=0.064)

Conclusions:

The results of this study suggest that delays in recanalization and an increased number of passes during MT may contribute to ASPECTS decay. However, yet-to-be-determined factors, as well as interactions between other potential risk factors, require further exploration.