Location-specific ASPECTS does not improve Outcome Prediction in Large Vessel Occlusion compared to Cumulative ASPECTS

Purpose: Individual regions of ASPECTS may contribute differently to clinical symptoms in large vessel occlusion (LVO). This study aimed to investigate whether considering specific ASPECTS subregions improves predictive performance for clinical outcomes.

Methods: A consecutive series of LVO patients affecting the MCA territory who underwent EVT between January 2015 and July 2020 was analyzed. Multivariate logistic regression assessed the individual impact of ASPECTS regions on good clinical outcome (mRS 0–2 at 90 days), and machine-learning logistic regression models were trained to predict good outcome using cumulative ASPECTS versus location-specific ASPECTS, compared using deLong's test.

Results: Of 1109 patients (mean age 77.3, 43.8% male), 419 achieved a good outcome. The strongest effects were observed for the insula (OR 0.56) and M5 (OR 0.53) regions. Accuracy was similar for cumulative ASPECTS (0.619) versus location-specific ASPECTS (0.629; p = 0.933).

Conclusion: Cumulative ASPECTS assessment in LVO remains a stable and reliable predictor of clinical outcome and is not inferior to a weighted, location-specific ASPECTS assessment.