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Case series
Favorable revascularization therapy in patients with ASPECTS ≤ 5 on DWI in anterior circulation stroke
  1. Isabelle Mourand1,
  2. Eitan Abergel2,
  3. Daniel Mantilla3,
  4. Xavier Ayrignac1,
  5. Tzvika Sacagiu3,
  6. Omer Faruk Eker3,
  7. Gregory Gascou3,
  8. Cyril Dargazanli3,
  9. Carlos Riquelme3,
  10. Marinette Moynier3,
  11. Alain Bonafé3,
  12. Caroline Arquizan1,
  13. Vincent Costalat3
  1. 1Department of Neurology, CHRU Gui de Chauliac, Montpellier, France
  2. 2Department of Neuroradiology, Rambam Health Care Campus, Haifa, Israel
  3. 3Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
  1. Correspondence to Dr Isabelle Mourand, Neurology Department, CHRU, Gui de Chauliac Hospital, 34295 Montpellier, France; i-mourand{at}


Background A low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke.

Objective To evaluate the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct.

Methods We retrospectively analyzed 108 consecutive patients presenting low ASPECTS on diffusion-weighted imaging. Sixty patients were treated by mechanical thrombectomy, including 34 patients who received simultaneously intravenous thrombolysis. A control group of 48 patients not eligible for reperfusion therapy gave us a perspective on the natural history. Clinical outcome was evaluated at 90 days using the modified Rankin Scale (mRS) score. Hemicraniectomy after malignant infarction, mortality, and symptomatic intracranial haemorrhage (sICH) were also reported.

Results Thrombolysis in Cerebral Infarction 2b–3 was assessed in 75% of treated patients. Reperfusion therapy led to significantly reduced disability (mRS score 0–2) at 90 days compared with the control group (30% vs 2.1%, p<0.001), hemicraniectomy (3.3% vs 22.9%, p=0.002), and death at 90 days (25% vs 47.9%, p=0.01). The sICH level was similar in treated patients and in the control group (p=0.78). Patients aged ≤70 years in the thrombectomy group had a significantly better clinical outcome than older patients (37.5% vs 10%, p=0.02), regardless of baseline characteristics or recanalization rate.

Conclusions In patients with acute stroke in the anterior circulation and ASPECTS ≤5 revascularization therapy contributes to a favorable clinical outcome at 90 days, especially in patients younger than 70 years.

  • mri
  • stroke
  • thrombectomy
  • thrombolysis

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  • Contributors Conception of the work: AB, VC. Acquisition of data: IM, EA, DM, TS, XA, OFE, GG, CD, CR, MM, CA. Analysis and interpretation of data and drafting the work: IM, EA Edited the manuscript for intellectual content: VC, AB, MM. Revising manuscript critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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