The role of infarct location in DWI-ASPECTS 0-5 acute stroke patients treated with thrombectomy

Objective: To determine whether hemisphere involvement and infarct location on the Alberta Stroke Program CT Score (ASPECTS) score template should serve as predictors of 90-day clinical outcome in acute ischemic stroke patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy.

Methods: We analyzed data of all consecutive patients included in the Endovascular Treatment in Ischemic Stroke (ETIS) registry between January 1, 2012 and January 31, 2018 who presented with a pretreatment DWI-ASPECTS 0-5 score and underwent thrombectomy. Multivariable analyses were performed in order to identify the role of infarct location and hemisphere involvement on good outcome defined by a modified Rankin Scale (mRS) score 0-2 at 90 days and on the whole distribution of mRS (shift analysis).

Results: 344 patients with a DWI-ASPECTS 0-5 (median 4, IQR, 3-5) were included. Neither infarct location nor hemisphere involvement were found to be independent predictors of good outcome. Involvement of the M6 region in right-sided strokes (adjusted odds ratio [aOR] 2.6, 99% confidence interval [CI] 1.14-5.8; P=0.003) and the internal capsule in left-sided strokes (aOR 2.6, 99% CI 0.8-7.9; P< 0.020) independently predicted increased disability on the mRS distribution in the affected subpopulations.

Conclusions: The results of our study suggests that neither hemisphere nor infarct location should be considered as exclusion criteria for endovascular thrombectomy in DWI-ASPECTS 0-5 patients. Nonetheless, the involvement of specific ROIs resulted associated with increased disability. They may provide valuable information regarding stroke management options and neurological recovery of use for caregivers in the post-acute phase.

Methods
We analyzed data of all consecutive anterior circulation stroke patients with a baseline DWI-ASPECTS 0-5 treated with thrombectomy from January 1st, 2012 to January 31st, 2018, included in the on-going prospective multicentric real-world ETIS (Endovascular Treatment in Ischemic Stroke) registry (NCT03776877).