No changes in diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography score from before to after mechanical thrombectomy for anterior circulation occlusion are associated with good outcomes

Background Although preoperative diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) is well known as a predictor of outcomes after mechanical thrombectomy (MT) for large-vessel occlusion (LVO), assessment of changes in DWI-ASPECT from before to after MT is rare. Therefore, we clarified the relationship between the change in DWI-ASPECTS and clinical outcomes. Methods In this retrospective single-center study, we enrolled 63 cases of anterior LVOs treated with MT between April 2015 and March 2022. Preoperative and postoperative DWI-ASPECTSs were calculated. DWI-ASPECTSs were categorized into cortical-ASPECTSs (c-ASPECTSs) and subcortical ASPECTSs and assessed. Additionally, medical variables related to patients, such as sex, age, National Institutes of Health Stroke Scale (NIHSS) score, and premorbid modified Rankin Scale (mRS) score, were evaluated. A good outcome was defined as an mRS score of 0 or 2 at 3 months. Results Forty-five patients met the inclusion criteria. Among the patients, 9 (20%) had a good outcome. The good outcome group showed significantly higher postoperative DWI-ASPECTs (median 8 vs. 5, p = 0.012) and c-ASPECTSs (median 4 vs. 3, p = 0.020) than the not-good outcome group. No changes in DWI-ASPECTSs and c-ASPECTSs from before to after MT were significantly associated with the good outcome ( p = 0.017, p = 0.016, respectively). The cut-off values for the good outcome on receiver operating characteristic curve analysis for differences between DWI-ASPECTSs and c-ASPECTSs was 0 [area under the curve (AUC) 0.77, sensitivity 0.67, specificity 0.78] and 0 [AUC 0.74, sensitivity 0.44, specificity 1.00]. Logistic regression analyses showed that baseline NIHSS score (odds ratio, 0.69; 95% confidence interval 0.48–1.00; p = 0.046) and postoperative DWI-ASPECTS (odds ratio, 2.27; 95% confidence interval 1.02–5.04; p = 0.039) were independent factors for the good outcome. Conclusions The good outcome of patients with anterior LVO was not associated with any changes in DWI-ASPECTSs and c-ASPECTSs from before to after MT. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The Japan Society for the Promotion of Science (JSPS) KAKENHI [JP21K16629 (Hiroaki Hashimoto)] supported this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of the Otemae Hospital (Osaka, Japan, approval no. CT210421002) gave the ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data in this study are available from the corresponding authors upon reasonable request and after additional ethics approval. * ASPECTS : Alberta Stroke Program Early Computed Tomography Score CCA : common carotid artery DWI : diffusion-weighted imaging ICA : internal carotid artery IQR : interquartile range MCA : middle cerebral artery mRS : modified Rankin Scale mTICI : modified Thrombolysis in Cerebral Infarction NIHSS : National Institutes of Health Stroke Scale SAH : subarachnoid hemorrhage tPA : tissue plasminogen activator