What is the interpretation of the ASPECTS (Alberta Stroke Programme Early Computed Tomography Score) score?

From the Guidelines

The ASPECTS score is a critical tool in evaluating the severity of stroke, ranging from 0 to 10, with higher scores indicating less ischemic damage, and should be interpreted in the context of clinical presentation and other patient factors to guide treatment decisions. The ASPECTS score is calculated by subtracting one point for each of ten defined brain regions showing early ischemic changes on a CT scan, with a score of 10 representing normal brain tissue and 0 indicating extensive damage throughout the middle cerebral artery territory 1. Key points to consider when interpreting the ASPECTS score include:

• Scores of 7 or higher generally suggest better outcomes and greater potential benefit from reperfusion therapies like thrombolysis or thrombectomy
• Scores below 7, particularly in the 0-5 range, often indicate more extensive damage and may predict poorer functional outcomes after treatment
• The assessment should always be considered alongside clinical presentation, time since symptom onset, and other patient factors when determining appropriate stroke management
• The use of ASPECTS score in conjunction with other imaging modalities, such as CT perfusion or MRI, can provide a more comprehensive understanding of the extent of ischemic damage and guide treatment decisions 1. It is essential to consider the most recent and highest quality evidence when interpreting the ASPECTS score, as the validity of the core-penumbra concept has recently been challenged, and the benefit of endovascular therapy in patients with ASPECTS <6 is uncertain, warranting further randomized, controlled trials 1.

From the Research

Interpretation of ASPECTS Score

The Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) is a scoring system used to evaluate the prognosis of patients with acute ischemic stroke. The interpretation of the ASPECTS score is as follows:

• A higher ASPECTS score is associated with a better outcome, while a lower score is associated with a worse outcome 2, 3, 4, 5.
• The ASPECTS score can be used to predict the effectiveness of thrombolysis and thrombectomy in patients with middle cerebral artery occlusion, with higher scores indicating a greater chance of complete recanalization and favorable long-term outcome 2, 4.
• A cutoff value of ASPECTS ≤ 7 has been determined to predict unfavorable outcomes, with patients having a significantly increased risk of poor outcomes 3.
• The ASPECTS score is also associated with infarct growth and final infarct volume, with higher scores indicating smaller infarct volumes and better outcomes 5.
• Post-stroke ASPECTS can be used to predict outcome after thrombectomy, with an ASPECTS-POST ≥ 7 associated with increased likelihood of favorable outcome at 90 days 5.

Key Findings

• The ASPECTS scoring system is a valuable and appropriate technique for evaluating the prognosis in acute ischemic stroke 3.
• Higher ASPECTS values are associated with favorable outcomes, while lower values are associated with poor outcomes 2, 3, 4, 5.
• The ASPECTS score can be used to guide treatment decisions, such as thrombolysis and thrombectomy, and to predict patient outcomes 2, 4, 5.