Location-Specific ASPECTS Paradigm in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Weighting neuroimaging findings based on eloquence can improve the predictive value of ASPECTS, possibly aiding in informed treatment decisions for acute ischemic stroke. PURPOSE:Our aim was to study the contribution of region-specific ASPECTS infarction to acute ischemic stroke outcomes. DATA SOURCES:We searched MEDLINE and EMBASE for reports on ASPECTS in patients with acute ischemic stroke from 2000 to March 2019.STUDY SELECTION: Two investigators independently reviewed articles and extracted data. Three-month poor functional outcome defined as mRS .2 was the primary end point.DATA ANALYSIS: A random-effects meta-analysis was performed to compare the association between infarct and mRS .2 among ASPECTS regions. Subanalyses included the following: laterality of stroke (left/right), imaging technique (NCCT or advanced imaging with DWI, CTP, or CTA), and interventional technique (IV-tPA/conservative management or mechanical thrombectomy).DATA SYNTHESIS: M6 infarct was most associated with poor functional outcome (OR ¼ 3.26; 95% CI, 2.21-4.80; P , .001). Pair-wise comparisons of ASPECTS regions regarding the association between infarct and mRS .2 were not significant, with the exception of M6 versus lentiform (P ¼ .009). However, pair-wise comparisons among ASPECTS regions were not significant among subgroup analyses.LIMITATIONS: Limitations were the heterogeneity of time points, neuroimaging modalities, and interventional techniques; limited studies for inclusion; publication bias among some comparisons; and the retrospective nature of included studies. CONCLUSIONS: Our study indicated an unequal impact of some ASPECTS subregions in predicting outcomes of patients with acute ischemic stroke. Stroke laterality, imaging technique, and interventional technique subgroup analyses showed no differences among ASPECTS regions in predicting outcome. Investigation in larger cohorts is required to assess the association of ASPECTS with acute ischemic stroke outcome.ABBREVIATIONS: AIS ¼ acute ischemic stroke; M1 ¼ anterior inferior frontal lobe; M2 ¼ temporal lobe; M3 ¼ inferior parietal and posterior temporal lobe; M4 ¼ anterior superior frontal lobe; M5 ¼ precentral and superior frontal lobe; M6 ¼ superior parietal lobe; MT ¼ mechanical thrombectomy; PRISMA ¼ Preferred Reporting Items for Systematic reviews and Meta-Analysis

Value of 4D CT Angiography Combined with Whole Brain CT Perfusion Imaging Feature Analysis under Deep Learning in Imaging Examination of Acute Ischemic Stroke

“…Hypoperfusion is the final pathway of all etiological mechanisms of cerebral ischemia. Dynamic CTP imaging can clearly display hemodynamic abnormalities in the early stage of cerebral infarction and provide relevant functional information of cerebral hemodynamics according to the ratio and correlation of various parameters [ 24 ]. In this study, CBV in peripheral area increased, while CBV and CBF in central area decreased.…”

Prediction of 90 day home time among patients with low baseline ASPECTS undergoing endovascular thrombectomy: results from Alberta’s Provincial Stroke Registry (QuICR)

“…In addition, home time (like mRS) does not capture quality of life measures. Thus it may be possible that patients with some residual deficits may have been safe to be discharged home, but the deficits may impact their quality of life, We did not analyze infarcts by topographical location nor did we analyze granular ASPECTS which may give a more detailed understanding of outcomes 28. Perfusion imaging was available for few patients and hence was not analyzed in detail.…”

Eloquence-based reperfusion scoring and its ability to predict post-thrombectomy disability and functional status

“…This general difficulty to consistently link regional non-reperfusion whether by infarct topography, region-based ASPECTS, or angiographic non-reperfusion with outcomes is also well-documented in the literature with the exception of right M6 regional infarction being commonly related to worse functional outcomes. 9,11,[14][15][16][17] However, these studies also generally all analyzed their primary outcome by mRS and generally did not examine the effect that successful versus not successful ET had on regional effects. Again, because of the tendency of the mRS to more heavily weigh motor-related outcomes, these results may also be biased in this manner.…”

“…[25][26][27] On the other hand, some have found the opposite to be true, and still others have found that laterality has no impact. 14,15,21,28,29 Discrepancies between stroke laterality and outcomes may also be related to delays in hospital presentation in non-dominant hemisphere strokes. 30 In terms of clinical application, our findings could help the operator to determine when it is appropriate to pursue additional thrombectomy attempts or abort the procedure depending on the anatomical location of the nonreperfused region considering its "risk-benefit" ratio versus a strictly volume-based perfusion assessment.…”

“…25–27 On the other hand, some have found the opposite to be true, and still others have found that laterality has no impact. 14,15,21,28,29 Discrepancies between stroke laterality and outcomes may also be related to delays in hospital presentation in non-dominant hemisphere strokes. 30…”