Page 167 - Ebook-Book JCMS 2025

Correlation of ASPECT Score, Affected Regions, and Clinical
Outcomes in Patients with Large Vessel Occlusion
Jittraphorn Wongphoek, Thittinan Rojthongpond*, Pornpatr Dharmasaroja
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University
*Corresponding Author E-mail: thittinanr@gmail.com
Background: Abstract
Acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) is a leading cause of
disability and mortality. The Alberta Stroke Program Early CT Score (ASPECTS) is widely
used to assess ischemic burden.
Methods: This retrospective cohort study included 200 patients with AIS due to LVO. The primary
outcome was to identify which ASPECTS regions were associated with poor
clinical outcomes (mRS 3–6). The secondary outcomes included evaluating the relationship
between infarction volume (quantified by the number of affected CT slices) and clinical
outcomes, as well as assessing the correlation between the total ASPECTS score and
clinical outcomes.
Results: This study included 200 patients with AIS due to LVO, of whom 98 (47%) underwent
mechanical thrombectomy (MT). 83 patients (42%) had favorable outcomes at 3 months.
In the MT group, infarction in the insular cortex (OR 3.67, p = 0.006) and M5 region (OR
2.30, p = 0.048) at admission were significantly associated with poor outcomes (mRS 3–6).
ASPECT scores demonstrated strong prognostic utility for favorable outcomes (mRS 0–2),
with an AUC of 0.703 at a cutoff of 6.5. The total infarct volume, measured as ≥9.5 slices
at admission significantly predicted poor outcomes, with AUC values of 0.68. Univariate
logistic regression confirmed that increasing infarct cuts strongly predicted poor outcomes
(p < 0.05).
Conclusion: This study demonstrates that infarction in specific regions, such as the insular cortex
and M5, is significantly associated with worse clinical outcomes, particularly in patients
undergoing mechanical thrombectomy. These findings emphasize the prognostic
significance of affected brain regions in LVO stroke. Additionally, higher ASPECTS scores
(≥7) are associated with favorable outcomes, while greater infarct volume (≥9.5 cuts at
admission) predicts poor prognosis.
Harmony in health: Innovation for Sustainable Medicine
165