Prognostic Analysis ofASPECTS Different Region in Patients with Acute Ischemic Stroke with Anterior Circulation Large Vessel Occlusionafter Mechanical Thrombectomy
Objective To explore the relationship between specific regional infarction and its volume and the prognosis of patients after mechanical thrombectomy for acute large vessel occlusion.Methods Clinical and imaging data were col-lected from patients with unilateral acute anterior circulation large vessel occlusion(internal carotid artery,proximal seg-ments of the middle cerebral artery Ml and M2)confirmed by CTA or DSA,who underwent mechanical thrombectomy(MT)treatment and achieved recanalization at the Second Affiliated Hospital of Nanchang University from January 2021 to October 2023.Clinical data included general information,baseline National Institutes of Health Stroke Scale(NIHSS)scores,and modified Rankin Scale(mRS)scores,etc.Imaging data included non-contrast CT scan,CT angiography,andCT perfusion imaging.Patients were divided into the good prognosis group(mRS≤2)and the poor prognosis group(mRS≥3)based on the mRS score at the 90-day follow-up.Preoperative core infarct volume,ischemic penumbra volume,mismatch ratio,ASPECTS total score,infarct region,and the proportion of core infarct were assessed using software.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors affecting patient prognosis.Correlation analysis was performed to plot the relationship curve between the proportion of core infarct and the probability of poor prog-nosis.The predictive efficacy of related indicators was evaluated using ROC curves.Results A total of 97 patients were included in the study,with 61 in the good prognosis group and 36 in the poor prognosis group.Univariate analysis showed that there were statistically significant differences between the good and poor prognosis groups in terms of baseline NIHSS scores,puncture to recanalization time,and symptomatic intracranial hemorrhage among the clinical indicators.In the ima-ging indicators,core infarct volume,mismatch ratio,ASPECTS total score,and infarctions in the Ml,M5,M6,internal cap-sule,and caudate nucleus were statistically significant between the two groups.Multivariate analysis before surgery showed that baseline NIHSS scores and infarctions in the internal capsule and M6 region were independent risk factors affecting pa-tient prognosis.Linear relationships indicated that the proportion of core infarct volume in the internal capsule or M6 region was positively correlated with poor prognosis.Non-linear relationships showed that when the proportion of core infarct volume in the internal capsule and M6 region combined was higher than 58.1％,the prognosis was almost linearly correlated with the proportion of core infarct volume.The area under the ROC curve(AUC)for evaluating prognosis using baseline NIHSS scores,infarct location,and the proportion of core infarct volume combined was 0.88,with a sensitivity of 75.0％and a spe-cificity of 93.4％.Conclusion The infarction status of the 10 regions in the ASPECTS has different impacts on the prog-nosis of patients after mechanical thrombectomy for acute large vessel occlusion,especially in the M6 region and internal capsule.Combined with baseline NIHSS score can reliably predict the prognosis of patients.Before deciding whether to per-form MT,the patients NIHSS score,core infarct region and volume proportion should be fully considered.
the Alberta stroke program early CT scoreLarge Vessel OcclusionCore infarct siteMechanical throm-bectomyAcute ischemic stroke
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