ASPECTS-Region-Dependent Functional Outcomes after Endovascular Therapy in Patients with Cardioembolic Stroke

Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis

“…Some studies suggested that superficial regions (M1–M6) are associated with worse functional outcomes [ 17 , 21 ], whereas others observed that infarcts in the M1–M3 regions were not associated with poor functional outcomes [ 27 ]. Our results suggest that infarcts in all 10 regions had higher means of poor functional outcome at 90 days [ 17 , 18 , 27 , 28 , 32 ]. Infarcts in M3 and internal capsule, which are the two least commonly involved regions, have almost 1.5 times to twice as much influence on functional dependence at 90 days than other ASPECTS regions.…”

“…A meta-analysis of 6 studies, reporting on the prevalence of infarcts in ASPECTS regions for the acute ischemic stroke, encompassing 1047 patients, revealed a significantly high pooled prevalence estimate of 51% of infarcts in the insular region (ES 0.51; 95% 0.38–0.64; z = 11.61, p < 0.001), followed by infarcts in the lentiform nucleus (ES 0.45; 95% CI 0.30–0.60; z = 8.86, p < 0.001), whereas infarcts in M3 regions have the least pooled estimated prevalence (ES 0.29; 95% CI 0.20–0.39; z = 10.06, p < 0.001) ( Figure 2 ) [ 15 , 17 , 18 , 20 , 27 , 28 ]. Notably, there was moderate to considerable heterogeneity between each ASPECTS region in the included studies (I 2 = 77.17–97.73%, p < 0.001).…”

“…Mean and median of reported ORs for poor functional outcome, with infarcts in each ASPECTS region, were estimated from six studies ( Table 4 ) [ 17 , 18 , 27 , 28 , 32 ]. Infarcts in the internal capsule (OR 4.07 ± 6.17) and M3 (OR 4.10 ± 5.70) regions were associated with the highest mean ORs for poor functional outcomes.…”

“…It is important to stratify patients’ risks of poor prognosis by their infarct’s location. Our study revealed that infarcts involving the insula are the most prevalent, followed by the involvement of the lentiform nucleus [ 15 , 17 , 18 , 20 , 27 , 28 ]. This can be attributed to their blood supplies that are mainly from the penetrating arteries, from the M2 segment and the lenticulostriate arteries from M1 segment of middle cerebral artery (MCA), which are both commonly occluded and have poor collateral blood supply [ 39 , 40 ].…”

Clinical value of automated volumetric quantification of early ischemic tissue changes on non-contrast CT

“…ASPECTS is the established gold standard for the assessment of early infarct signs on NCCT, and while it constitutes an implicitly easy-to-use method with good prognostic value, it has also come under scrutiny because of its oversimplification of the tissue status, which does not account for regional differences in brain function and, in addition, more precise quantifications of the infarcted tissue volume. Specifically, previous papers have demonstrated the differential weight of different ASPECTS regions for the final functional outcome of patients undergoing EVT18 19 26–28 as well as finding substantially different ischemic volumes in patients presenting with similar ASPECTS scores, with a different impact on the likelihood of intracerebral hemorrhage 17. Accordingly, Tanaka et al in a recent paper developed a modified ASPECTS based on MRI to improve the prediction of intracranial hemorrhages 29.…”