BACKGROUND AND PURPOSE: Both ASPECTS and core volume on CTP are used to estimate infarct volume in acute ischemic
stroke. To evaluate the potential role of ASPECTS for acute endovascular treatment decisions, we studied the correlation between
ASPECTS and CTP core, depending on the timing and the presence of large-vessel occlusion.
MATERIALS AND METHODS: We retrospectively reviewed all MCA acute ischemic strokes with standardized reconstructions of
CTP maps entered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) registry. Correlation between ASPECTS and CTP
core was determined for early (,6 hours) versus late (6–24 hours) times from stroke onset and in the presence versus absence of
large-vessel occlusion. We used correlation coefficients and adjusted multiple linear regression models.
RESULTS: We included 1046 patients with a median age of 71.4 years (interquartile range, IQR ¼ 59.8–79.4 years), an NIHSS score of
12 (IQR, 6–18), an ASPECTS of 9 (IQR, 7–10), and a CTP core of 13.6 mL (IQR, 0.6–52.8 mL). The overall correlation between ASPECTS
and CTP core was moderate (r ¼ –0.49, P , .01) but significantly stronger in the late-versus-early window (r ¼ –0.56 and r ¼ –
0.48, respectively; P ¼ .05) and in the presence versus absence of large-vessel occlusion (r ¼ –0.40 and r ¼ –0.20, respectively;
P , .01). In the regression model, the independent association between ASPECTS and CTP core was confirmed and was twice as
strong in late-arriving patients with large-vessel occlusion (b ¼ –0.21 per 10 mL; 95% CI, 0.27 to –0.15; P , .01) than in the overall
population (b ¼ –0.10; 95% CI, 0.14 to –0.07; P , .01).
CONCLUSIONS: In a large cohort of patients with acute ischemic stroke, we found a moderate correlation between ASPECTS and CTP
core. However, this was stronger in patients with large-vessel occlusion and longer delay from stroke onset. Our results could support
the use of ASPECTS as a surrogate marker of CTP core in late-arriving patients with acute ischemic stroke with large-vessel occlusion