AUTHOR=Rodriguez Maria Paz , Taleb Shayandokht , Lee Jenny Ji-hyun , Liebeskind David S. , Saver Jeffrey L. 

TITLE=AC-ASPECTS, ACh-ASPECTS, and H-ASPECTS: new imaging scales to assess territorial and total cerebral hemispheric ischemic injury

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1397120

DOI=10.3389/fneur.2024.1397120

ISSN=1664-2295

ABSTRACT=Background: Extent of ischemic injury in acute stroke is assessed in clinical practice using the Acute Stroke Prognosis Early CT Score (ASPECTS) rating system. However, current ASPECTS semiquantitative, topographic scales assess only the middle cerebral artery (original ASPECTS) and posterior cerebral artery (PC-ASPECTS) territories. For treatment decision-making in patients with anterior cerebral artery (ACA) occlusions and internal carotid artery (ICA) occlusions with large ischemic cores, measures of all hemispheric regions are desirable.In this cohort study, anatomic rating systems were developed for the anterior cerebral (AC-ASPECTS, 3 points) and anterior choroidal artery (ACh-ASPECTS, 1 point) territories. In addition, a total supratentorial hemisphere (H-ASPECTS, 16 points) score was calculated as the sum of the middle cerebral artery ASPECTS (10 regions), supratentorial PC-ASPECTS (2 regions), AC-ASPECTS (3 regions) and ACh-ASPECTS (1 region). Three raters applied these scales to initial and 24h CT and MR images in consecutive patients with ischemic stroke due to ICA, M1 middle cerebral artery (MCA), and ACA occlusions.Results: Imaging ratings were obtained for 96 scans in 50 consecutive patients with age 74.8 (±14.0), 60% female, NIHSS 15.5 (9.25-20), and occlusion locations ICA 34%; M1-MCA 58%; and ACA 8%. Treatments included endovascular thrombectomy +/-thrombolysis in 72%, thrombolysis alone in 8%, and hemicraniectomy in 4%. Among experienced clinicians, inter-rater reliability for AC-, ACh-, and H-ASPECTS scores was substantial (kappa values 0.61-0.80). AC-ASPECTS abnormality was present in 14% of patients and ACh-ASPECTS abnormality in 2%. Among patients with ACA and ICA occlusions, H-ASPECTS scores compared with original ASPECTS scores were more strongly associated with disability level at discharge, ambulatory status at discharge, discharge destination, and combined inpatient mortality and discharge to hospice.AC-ASPECTS, ACh-ASPECTS, and H-ASPECTS expand the scope of acute ischemic stroke imaging scores and increase correlation with functional outcomes. This additional information may enhance prognostication and decision-making, including for endovascular thrombectomy and hemicraniectomy.