Location-specific ASPECTS paradigm in acute ischemic stroke: A systematic review and meta-analysis

Background: Weighting neuroimaging findings based on eloquence can improve the predictive value of ASPECTS, possibly aiding in informed treatment decisions for acute ischemic stroke. Purpose: Our aim was to study the contribution of region-specific ASPECTS infarction to acute ischemic stroke outcomes. Data Sources: We searched MEDLINE and EMBASE for reports on ASPECTS in patients with acute ischemic stroke from 2000 to March 2019. Study Selection: Two investigators independently reviewed articles and extracted data. Three-month poor functional outcome defined as mRS >2 was the primary end point. Data Analysis: A random-effects meta-analysis was performed to compare the association between infarct and mRS. 2 among ASPECTS regions. Subanalyses included the following: laterality of stroke (left/right), imaging technique (NCCT or advanced imaging with DWI, CTP, or CTA), and interventional technique (IV-tPA/conservative management or mechanical thrombectomy). Data Synthesis: M6 infarct was most associated with poor functional outcome (OR = 3.26; 95% CI, 2.21-4.80; P <. 001). Pair-wise comparisons of ASPECTS regions regarding the association between infarct and mRS >2 were not significant, with the exception of M6 versus lentiform (P=. 009). However, pair-wise comparisons among ASPECTS regions were not significant among subgroup analyses. Limitations: Limitations were the heterogeneity of time points, neuroimaging modalities, and interventional techniques; limited studies for inclusion; publication bias among some comparisons; and the retrospective nature of included studies. Conclusions: Our study indicated an unequal impact of some ASPECTS subregions in predicting outcomes of patients with acute ischemic stroke. Stroke laterality, imaging technique, and interventional technique subgroup analyses showed no differences among ASPECTS regions in predicting outcome. Investigation in larger cohorts is required to assess the association of ASPECTS with acute isch emic stroke outcome.