BACKGROUND AND PURPOSE The relative contribution of each Alberta Stroke Program Early CT Score (ASPECTS) region to poststroke disability likely varies across regions. Determining the relative weights of each ASPECTS region may improve patient selection for endovascular stroke therapy (EST). METHODS In the combined Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT), Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and Solitaire Flow Restoration with the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) databases, we identified patients treated with the Solitaire stent retriever. Using 24-h CT scan, a multivariate ordinal regression was used to determine the relative contribution of each ASPECTS region to clinical outcome separately in each hemisphere. The coefficients from the regression were used to create a weighted ASPECTS (wASPECTS), which was compared with the original ASPECTS to predict 90-day modified Rankin Scale disability outcomes in an independent validation cohort. RESULTS Among 342 patients treated with EST, the average age was 67 years, 57% were female, and the median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13-20). The median ASPECTS at presentation was 8 (IQR 7-10). The most commonly involved ASPECTS regions on 24-h CT were the lentiform nuclei (70%), insula (55%), and caudate (52%). In multivariate analysis, preservation of M6 (β = 9.7) and M4 (β = 4.4) regions in the right hemisphere was most strongly predictive of good outcome. For the left hemisphere, M6 (β = 5.5), M5 (β = 4.1), and M3 (β = 3.1) generated the greatest parameter estimates, though they did not reach statistical significance. A wASPECTS incorporating all 20 parameter estimates resulted in improved discrimination against the original ASPECTS in the independent cohort (C-statistic 0.78 vs. 0.67, right hemisphere). CONCLUSIONS For both right and left hemisphere, preservation of the high cortical regions was more strongly associated with improved outcomes compared to the deep regions. Our findings support taking into consideration the location and relative weightings of the involved ASPECTS regions when evaluating a patient for EST.

中文翻译：

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血管内治疗中卒中后残疾的区域贡献。

背景和目的 每个艾伯塔省卒中计划早期 CT 评分 (ASPECTS) 区域对卒中后残疾的相对贡献可能因区域而异。确定每个 ASPECTS 区域的相对权重可以改善血管内卒中治疗 (EST) 的患者选择。方使用 Solitaire 支架取栓器。使用 24 小时 CT 扫描，使用多变量序数回归来确定每个 ASPECTS 区域对每个半球的临床结果的相对贡献。回归的系数用于创建加权 ASPECTS (wASPECTS)，将其与原始 ASPECTS 进行比较，以预测独立验证队列中 90 天修正的 Rankin 量表残疾结果。结果 在接受 EST 治疗的 342 名患者中，平均年龄为 67 岁，57% 为女性，美国国立卫生研究院卒中量表 (NIHSS) 评分中位数为 17 (IQR 13-20)。就诊时的中位 ASPECTS 为 8 (IQR 7-10)。24 小时 CT 上最常见的 ASPECTS 区域是豆状核 (70%)、岛状核 (55%) 和尾状核 (52%)。在多变量分析中，右半球 M6 (β = 9.7) 和 M4 (β = 4.4) 区域的保留最能强烈预测良好的结果。对于左半球，M6 (β = 5.5)、M5 (β = 4.1) 和 M3 (β = 3.1) 产生了最大的参数估计，尽管它们没有达到统计学意义。包含所有 20 个参数估计的 wASPECTS 提高了对独立队列中原始 ASPECTS 的区分度（C 统计量 0.78 对 0.67，右半球）。结论 对于右半球和左半球，与深部区域相比，保留高皮质区域与改善结果的相关性更强。我们的研究结果支持在评估患者的 EST 时考虑相关 ASPECTS 区域的位置和相对权重。与深层区域相比，保留高皮质区域与改善结果的相关性更强。我们的研究结果支持在评估患者的 EST 时考虑相关 ASPECTS 区域的位置和相对权重。与深层区域相比，保留高皮质区域与改善结果的相关性更强。我们的研究结果支持在评估患者的 EST 时考虑相关 ASPECTS 区域的位置和相对权重。