Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization

Gabriel Broocks*, Helge Kniep, Peter Schramm, Uta Hanning, Fabian Flottmann, Tobias Faizy, Michael Schönfeld, Lukas Meyer, Gerhard Schön, Linda Aulmann, Björn Machner, Georg Royl, Jens Fiehler, Andre Kemmling

*Corresponding author for this work
9 Citations (Scopus)


Background Benefit of thrombectomy in patients with a low initial Alberta Stroke Program Early CT Score (ASPECTS) is still uncertain. We hypothesized that, despite low ASPECTS, patients may benefit from endovascular recanalization if good collaterals are present. Methods Ischemic stroke patients with large vessel occlusion in the anterior circulation and an ASPECTS of ≤5 were analyzed. Collateral status (CS) was assessed using a 5-point-scoring system in CT angiography with poor CS defined as CS=0-1. Clinical outcome was determined using the modified Rankin Scale (mRS) score after 90 days. Edema formation was measured in admission and follow-up CT by net water uptake. Results 27/100 (27%) patients exhibited a CS of 2-4. 50 patients underwent successful vessel recanalization and 50 patients had a persistent vessel occlusion. In multivariable logistic regression analysis, collateral status (OR 3.0; p=0.003) and vessel recanalization (OR 12.2; p=0.009) significantly increased the likelihood of a good outcome (mRS 0-3). A 1-point increase in CS was associated with 1.9% (95% CI 0.2% to 3.7%) lowered lesion water uptake in follow-up CT. Conclusion Endovascular recanalization in patients with ASPECTS of ≤5 but good collaterals was linked to improved clinical outcome and attenuated edema formation. Collateral status may serve as selection criterion for thrombectomy in low ASPECTS patients.

Original languageEnglish
JournalJournal of neurointerventional surgery
Issue number8
Pages (from-to)747-752
Number of pages6
Publication statusPublished - 01.08.2020

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