Prognostic Value of Postcontrast CT Alberta stroke program early CT score (ASPECTS) in Endovascular Thrombectomy for Acute Ischemic Stroke

PURPOSE The Alberta Stroke Program Early CT Score (ASPECTS) derived from noncontrast CT (NCCT) has been investigated as a prognostic factor for patients with acute ischemic stroke. This study aims to assess whether postcontrast CT (PCCT) ASPECTS serves as a superior prognostic predictor for AIS patients undergoing endovascular thrombectomy (EVT). MATERIALS AND METHODS We retrospectively analyzed 120 patients with anterior circulation large vessel occlusion who underwent both PCCT and NCCT prior to EVT. ASPECTS were independently scored on each modality. The favorable functional outcome was defined as a 3-month modified Rankin Scale (mRS) of 0–3. Univariate and multivariate logistic regression were used to identify predictors. Predictive performance was compared using receiver operating characteristic (ROC) analysis. RESULTS PCCT-ASPECTS ≥ 7 was associated with favorable outcomes significantly in the univariate analysis (crude OR 3.62, 95% CI: 1.26–10.39; p = 0.017) and borderline significance in the multivariate analysis (adjusted odds ratio [AOR] 3.32; 95% CI: 0.96–11.49; P = 0.058), whereas NCCT-ASPECTS was not. PCCT-ASPECTS demonstrated higher predictive accuracy (AUC = 0.723) compared to NCCT-ASPECTS (AUC = 0.687), although the difference was not statistically significant (P = 0.305). Among patients with poor collateral status, 57% (21 out of 37) exhibited a > 1-point decline in PCCT ASPECTS compared to NCCT ASPECTS, which was significantly higher than those with good collateral status (14%; p < 0.001). CONCLUSION PCCT-ASPECTS more effectively predicts post-EVT outcomes than NCCT-ASPECTS and may serve as a practical surrogate for infarct burden and collateral perfusion status.