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Original research
ASPECTS decay during inter-facility transfer in patients with large vessel occlusion strokes
  1. Maxim Mokin1,
  2. Rishi Gupta2,
  3. Waldo R Guerrero1,
  4. David Z Rose1,
  5. William S Burgin1,
  6. Sananthan Sivakanthan1
  1. 1Department of Neurology, University of South Florida, Tampa, Florida, USA
  2. 2Wellstar Neurosurgery, Marietta, Georgia, USA
  1. Correspondence to Dr Maxim Mokin, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA; maximmokin{at}


Background Favorable imaging profile according to the Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast head CT is a key criterion for the selection of patients with ischemic stroke from large vessel occlusion (LVO) for IA revascularization therapies.

Objective To analyze factors associated with changes in ASPECTS during inter-hospital transfer and to determine how deterioration of ASPECTS affects eligibility for endovascular procedures.

Methods We analyzed factors associated with changes in ASPECTS during inter-hospital transfer and their potential impact on eligibility for IA stroke therapies in patients with anterior circulation ischemic strokes. Clinical and demographic characteristics between patients with favorable (ASPECTS ≥6) and unfavorable (ASPECTS <6) imaging on repeat CT were compared.

Results Stroke evolution towards unfavorable ASPECTS occurred in 13/42 (31%) patients who initially had a favorable imaging profile at outside hospitals. A higher National Institutes of Health Stroke Scale (NIHSS) score was the only significant predictor of ASPECTS decay, whereas other clinical characteristics, such as the use of IV thrombolysis and site of LVO, were similar between the two groups.

Conclusions In our cohort, one out of three patients became ineligible for IA thrombectomy because of unfavorable ASPECTS ‘decay’ following inter-hospital transfer. Except for NIHSS severity, baseline clinical factors could not identify which patients were at risk for ASPECTS deterioration.

  • Thrombectomy
  • CT
  • Stroke

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