Screening flowchart.

Introduction
Over the last decade, there have been significant advances in treatments for anterior ischemic stroke, most notably endovascular thrombectomy (EVT). Despite the success of EVT on overall outcomes, intracerebral hemorrhage (ICH) is an important post-procedure complication, often associated with mortality and disability. Hence, predicting the risk of ICH can inform EVT decision making. The ASPECT score is used globally to predict patients’ prognosis post-reperfusion therapy. Our objective is to perform a systematic review to collect and synthesize data on the association between ASPECT scores on CT, CTP and DWI-MRI (CT-ASPECT, CTP-ASPECT, and DWI-ASPECT) and the risk of symptomatic ICH after EVT for anterior circulation strokes.
Methods and analysis
We will conduct a broad search of various electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews) to identify studies published after January 1st, 2012 (commonly accepted as the beginning of the modern EVT era based on availability of stent-retrievers). Two independent reviewers will screen and include studies evaluating associations between symptomatic ICH after thrombectomy and baseline CT-ASPECT, CTP-ASPECT and DWI-ASPECT scores. Data will be extracted to quantify the risk of sICH after EVT based on the ASPECT scoring.
Trial registration
PROSPERO registration number:CRD42023459860.

引言
近十年来，前循环缺血性脑卒中的治疗领域取得了显著进展，其中血管内取栓术（endovascular thrombectomy, EVT）最为突出。尽管EVT在改善患者整体预后方面效果显著，但术后颅内出血（intracerebral hemorrhage, ICH）仍是一种重要并发症，常与患者死亡及残疾结局相关。因此，提前预测ICH发生风险可为EVT的临床决策提供重要参考。目前，ASPECT评分已在全球范围内被用于预测患者接受再灌注治疗后的预后情况。本研究旨在开展一项系统综述，收集并整合相关数据，以明确CT、CT灌注成像（CTP）及弥散加权磁共振成像（DWI-MRI）对应的ASPECT评分（分别为CT-ASPECT、CTP-ASPECT与DWI-ASPECT）与前循环缺血性脑卒中患者接受EVT后症状性颅内出血（symptomatic ICH）风险之间的关联。

方法与分析
本研究将对多个电子数据库（MEDLINE、EMBASE、CINAHL、PsycINFO、Web of Science及Cochrane系统综述数据库）进行全面检索，以筛选2012年1月1日之后发表的相关研究——基于支架取栓器的临床应用，该时间节点通常被认为是现代EVT时代的开端。将由两名独立的研究者分别进行文献筛查与纳入筛选，纳入评估取栓术后症状性ICH与基线CT-ASPECT、CTP-ASPECT及DWI-ASPECT评分之间关联的研究。本研究将提取相关数据，基于ASPECT评分量化EVT术后症状性ICH的发生风险。

试验注册
PROSPERO注册编号：CRD42023459860。