Supplementary Material for: Regional Contributions to Poststroke Disability in Endovascular Therapy

Background and Purpose: The relative contribution of each Alberta Stroke Program Early CT Score (ASPECTS) region to poststroke disability likely varies across regions. Determining the relative weights of each ASPECTS region may improve patient selection for endovascular stroke therapy (EST). Methods: In the combined Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT), Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and Solitaire Flow Restoration with the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) databases, we identified patients treated with the Solitaire stent retriever. Using 24-h CT scan, a multivariate ordinal regression was used to determine the relative contribution of each ASPECTS region to clinical outcome separately in each hemisphere. The coefficients from the regression were used to create a weighted ASPECTS (wASPECTS), which was compared with the original ASPECTS to predict 90-day modified Rankin Scale disability outcomes in an independent validation cohort. Results: Among 342 patients treated with EST, the average age was 67 years, 57% were female, and the median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13–20). The median ASPECTS at presentation was 8 (IQR 7–10). The most commonly involved ASPECTS regions on 24-h CT were the lentiform nuclei (70%), insula (55%), and caudate (52%). In multivariate analysis, preservation of M6 (β = 9.7) and M4 (β = 4.4) regions in the right hemisphere was most strongly predictive of good outcome. For the left hemisphere, M6 (β = 5.5), M5 (β = 4.1), and M3 (β = 3.1) generated the greatest parameter estimates, though they did not reach statistical significance. A wASPECTS incorporating all 20 parameter estimates resulted in improved discrimination against the original ASPECTS in the independent cohort (C-statistic 0.78 vs. 0.67, right hemisphere). Conclusions: For both right and left hemisphere, preservation of the high cortical regions was more strongly associated with improved outcomes compared to the deep regions. Our findings support taking into consideration the location and relative weightings of the involved ASPECTS regions when evaluating a patient for EST.背景与目的：阿尔伯塔卒中项目早期CT评分（Alberta Stroke Program Early CT Score, ASPECTS）的每个亚区对卒中后残疾的相对贡献可能因脑区而异。明确各ASPECTS亚区的相对权重，或可改善血管内卒中治疗（endovascular stroke therapy, EST）的患者筛选。 方法：本研究整合了Solitaire血流恢复取栓意向试验（SWIFT）、急性血管再通Solitaire血流恢复取栓研究（STAR）以及作为一线血管内治疗的Solitaire血流恢复取栓意向试验（SWIFT PRIME）三项数据库，筛选出接受Solitaire支架取栓器治疗的患者。以24小时CT扫描结果为基础，采用多变量有序回归分别分析两侧大脑半球各ASPECTS亚区对临床结局的相对贡献。利用回归得到的系数构建加权ASPECTS（wASPECTS），并在独立验证队列中与原始ASPECTS对比，以预测患者90天改良Rankin量表（modified Rankin Scale, mRS）残疾结局。 结果：本研究共纳入342例接受EST治疗的患者，平均年龄67岁，女性占比57%，美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分中位数为17（四分位距13~20）。就诊时ASPECTS评分中位数为8（四分位距7~10）。24小时CT扫描显示，受累最常见的ASPECTS亚区为豆状核（70%）、岛叶（55%）及尾状核（52%）。多变量分析显示，右侧大脑半球的M6（β=9.7）与M4（β=4.4）亚区保留情况与良好临床结局的相关性最强。左侧大脑半球中，M6（β=5.5）、M5（β=4.1）及M3（β=3.1）的参数估计值最大，但未达到统计学显著性。纳入全部20项参数估计值的wASPECTS在独立队列中对结局的区分度优于原始ASPECTS（右侧大脑半球C统计量：0.78 vs. 0.67）。 结论：无论左侧还是右侧大脑半球，皮层亚区的保留与良好临床结局的相关性均强于深部亚区。本研究结果支持在评估EST候选患者时，需考虑受累ASPECTS亚区的位置及其相对权重。