RT Journal Article SR Electronic T1 Follow-up ASPECTS improves prediction of potentially lethal malignant edema in patients with large middle cerebral artery stroke JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP jnis-2023-021145 DO 10.1136/jnis-2023-021145 A1 Stafford, Rebecca A1 Chatzidakis, Stefanos A1 Kim, Ivy So Yeon A1 Zhang, Yihan A1 Rina, Andriani A1 Brush, Benjamin A1 Mian, Asim A1 Abdalkader, Mohamad A1 Greer, David M A1 Smirnakis, Stelios M A1 Feske, Steven K A1 Dupuis, Josée A1 Ong, Charlene J YR 2023 UL http://jnis.bmj.com/content/early/2023/12/30/jnis-2023-021145.abstract AB Background Recent studies have shown that follow-up head CT is a strong predictor of functional outcomes in patients with middle cerebral artery stroke and mechanical thrombectomy. We sought to determine whether total and/or regional follow-up Alberta Stroke Program Early CT Score (ASPECTSfu) are associated with important clinical outcomes during hospitalization and improve the performance of clinical prediction models of potentially lethal malignant edema (PLME).Methods We conducted a retrospective study of patients at three medical centers in a major North American metropolitan area with baseline and follow-up head CTs after large middle cerebral artery stroke between 2006 and 2022. We used multivariable logistic regression to test the association of total and regional ASPECTSfu with PLME (cerebral edema related death or surgery), adjusting for total baseline ASPECTS, age, sex, admission glucose, tissue plasminogen activator, and mechanical thrombectomy. We compared existing clinical risk models with and without total or regional ASPECTSfu using area under the curve.Results In our 560 patient cohort, lower total ASPECTSfu was significantly associated with higher odds of PLME when adjusting for confounders (OR 1.69, 95% CI 1.49 to 2.0), and improved model discrimination compared with existing models and models using baseline ASPECTS. Deep territory involvement (OR 2.46, 95% CI 1.53 to 4.01) and anterior territory involvement (OR 3.23, 95% CI 1.88 to 5.71) were significantly associated with PLME.Conclusions Lower ASPECTSfu and certain locations on regional ASPECTSfu, including deep and anterior areas, were significantly associated with PLME. Including ASPECTSfu information improved discrimination of established edema prediction models and could be used immediately to help facilitate clinical management decisions and prognostication.Data are available upon reasonable request. Deidentified data are available upon request and establishment of a data use agreement. Please email the corresponding author for access.