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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0045-1808064
Original Article

Lower DWI-ASPECTS Score in Cortical Regions Predicts Unfavorable Outcome after Successful Thrombectomy

Satoshi Hori 
1   Department of Neurosurgery, Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan
2   Department of Neurosurgery, Hadano Red Cross Hospital, Hadano, Kanagawa, Japan
,
Ryutaro Furudate
1   Department of Neurosurgery, Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan
,
Izumi Kumagai
1   Department of Neurosurgery, Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan
,
Chikashi Aoyagi
1   Department of Neurosurgery, Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan
,
Nobuo Hirota
3   Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
,
Tetsuya Yamamoto
2   Department of Neurosurgery, Hadano Red Cross Hospital, Hadano, Kanagawa, Japan
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Abstract

Background Mechanical thrombectomy has been established as an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, the factors predicting poor outcomes despite successful reperfusion after thrombectomy remain unclear.

Methods This study included 50 patients who achieved successful reperfusion after mechanical thrombectomy between January 2014 and March 2021. The diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was stratified into deep (dDWI-ASPECTS) and cortical (cDWI-ASPECTS) components. Baseline clinical characteristics and procedural factors were statistically analyzed to identify variables associated with unfavorable outcomes, defined as a modified Rankin scale score of 3 to 6.

Results Seventeen patients (34%) achieved favorable outcomes, while 33 (66%) had unfavorable outcomes. The cDWI-ASPECTS were significantly higher in the favorable outcome group compared with the unfavorable outcome group (p = 0.01), whereas no significant differences were observed in the dDWI-ASPECTS. Multivariate analysis identified older age (p < 0.01; odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.04–1.27), lower baseline cDWI-ASPECTS (p < 0.01; OR: 2.71; 95% CI: 1.30–5.56), and higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.03; OR: 1.21; 95% CI: 1.02–1.44) as independent predictors of unfavorable outcomes.

Conclusion A lower baseline cDWI-ASPECTS score serves as a predictive factor for unfavorable outcomes following successful thrombectomy, particularly in older AIS-LVO patients with higher baseline NIHSS scores.

Keywords

DWI-ASPECTS - thrombectomy - acute ischemic stroke - large vessel occlusion


Publication History

Article published online:
22 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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