Evidence map›Paper›PMID 42258336›Full record

ArticleEuropean stroke journal2026

ASPECTS as a surrogate marker of core-perfusion mismatch in late-window large vessel occlusion stroke.

Pierre Seners, Nicole Yuen, Davide Strambo, Emmanuel Carrera, Mirjam R Heldner, Jean-Marc Olivot, Michael Mlynash, Jeremy J Heit, Elisabeth Dirren, Patrik Michel and 5 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

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4 · The record

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5 · Who and what money

Authors and funding

15 authors.

Pierre SenersNeurology Department, Hôpital Fondation A. de Rothschild, FHU NeuroVasc 2030, Paris, France.ORCID 0000-0002-2134-0691
Nicole YuenStanford Stroke Center, Stanford, CA, United States.
Davide StramboStroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.ORCID 0000-0003-4429-2714
Emmanuel CarreraNeurology Department, Geneva University Hospitals, Geneva, Switzerland.
Mirjam R HeldnerNeurology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Jean-Marc OlivotStroke-Link F-CRIN Research Network, Lille, France.
Michael MlynashStanford Stroke Center, Stanford, CA, United States.
Jeremy J HeitRadiology Department, Stanford University, Palo Alto, CA, United States.
Elisabeth DirrenNeurology Department, Geneva University Hospitals, Geneva, Switzerland.ORCID 0000-0001-7757-4967
Patrik MichelStroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.ORCID 0000-0003-4954-7579
Christophe CognardStroke-Link F-CRIN Research Network, Lille, France.ORCID 0000-0003-4287-2627
Julien SavatovskyRadiology Department, Hôpital Fondation A. de Rothschild, Paris, France.
William AlmiriDepartment of Diagnostic and Interventional Neuroradiology, University Hospital and University of Bern, Bern, Switzerland.
Maarten G LansbergStanford Stroke Center, Stanford, CA, United States.
Gregory W AlbersStanford Stroke Center, Stanford, CA, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn acute stroke due to a large vessel occlusion (AIS-LVO), identifying a core-perfusion mismatch guides reperfusion therapy in extended time window, but perfusion imaging is not universally available. We investigated whether the Alberta Stroke Program Early CT Score (ASPECTS) is associated with core-perfusion mismatch and could serve as a surrogate imaging marker. PATIENTS AND

methodsWe retrospectively analysed a large multicentre international unselected cohort of consecutive AIS-LVO patients imaged between 4.5 and 24 h from last time seen well, with baseline CT- or MR-perfusion imaging. Core-perfusion mismatch was defined as a mismatch volume ≥ 15 mL and a mismatch ratio ≥ 1.8 using automated software. CT and MRI cohorts were analysed separately.

resultsAmong 531 included patients, 182 underwent CT and 349 MRI. Core-perfusion mismatch was present in 86% of CT patients and 62% of MRI patients. Alberta Stroke Program Early CT Score was strongly associated with mismatch in both cohorts (P < .001). In the MRI cohort, ASPECTS predicted mismatch with an area under the receiver operating characteristic curve (AUC) of 0.843 (95% CI, 0.797-0.890), with an optimal cutoff ≥ 6, yielding sensitivity 0.87, specificity 0.72, positive predictive value (PPV) 0.84 and negative predictive value (NPV) 0.77. In the CT cohort, the AUC was 0.801 (95% CI, 0.698-0.904), with an optimal cutoff ≥ 7, yielding sensitivity 0.74, specificity 0.81, PPV 0.96 and NPV 0.34.

conclusionThe high PPV of ASPECTS ≥ 6 on MRI and ASPECTS ≥ 7 on CT supports their potential use as pragmatic enrichment criteria for patient selection in future late-window AIS-LVO trials, when perfusion imaging is unavailable, as surrogate markers of salvageable tissue.

Indexed as

StrokeAgedAged, 80 and overFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedPerfusion Magnetic Resonance ImagingRetrospective StudiesTomography, X-Ray Computedmismatchstrokethrombectomythrombolysis

Identifiers

PMID42258336
PMCPMC13245164

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