Objective:

We aimed to assess how Alberta Stroke Program Early CT Score (ASPECTS) and CT perfusion (CTP) core infarct volume correlate in patients undergoing large-core endovascular therapy (EVT), and which modality performs better for outcome prediction.

Background:

The ASPECTS from non-contrast CT (NCCT) and CTP estimates have been used in recent trials to triage patients with large vessel occlusion (LVO) for EVT. Recent EVT trials demonstrated that patients with large infarct core (ASPECTS 0–5) can still benefit from EVT. The reliability and upper limit of CTP core volume estimates in this population remain unclear.

Design/Methods:

From a multicenter, prospectively collected registry, consecutive patients with pre-treatment large core infarct defined by NCCT ASPECTS and CTP who underwent EVT were included. Baseline characteristics were compared between good versus poor outcome (modified Rankin Score 0–3 vs 4–6). ASPECTS–CTP correlation was assessed with Spearman’s coefficient. Three multivariable logistic regression models (ASPECTS-based, CTP-based, combined) evaluated predictors of poor outcome, with discrimination assessed by AUROC and DeLong test, further validated by 300 bootstrap resamples.

Results:

Among 64 patients, median age was 64 years, 56.2% were female, and median NIHSS was 18 [IQR 15–22]. Poor outcome patients were older and had larger CTP cores, while other factors did not differ. CTP core volume was frequently underestimated but negatively correlated with NCCT ASPECTS (ρ = –0.459, p < 0.001). On multivariable regression, age and CTP core volume independently predicted poor 90-day outcome. Final AUROCs were above 0.8, and optimism-corrected AUROCs remained high (0.787–0.840) after bootstrap validation.

Conclusions: