Clinical, laboratory, and radiological features influencing admission DWI-ASPECTS in stroke patients with middle cerebral artery occlusion undergoing mechanical thrombectomy

TL;DR

This study identifies clinical and lab factors that influence a brain imaging score used to assess stroke severity in patients undergoing a specific treatment.

Contribution

The study is the first to associate aPTT and oxygen saturation with DWI-ASPECTS, identifying modifiable factors that could improve stroke outcomes.

Findings

Lower DWI-ASPECTS is associated with younger age, male sex, and higher diastolic pressure.

Oxygen saturation and aPTT are newly identified modifiable factors linked to DWI-ASPECTS.

FLAIR positivity and unknown onset time are significant predictors of lower DWI-ASPECTS.

Abstract

The Diffusion-Weighted Imaging Alberta Stroke Programme Early Computed Tomography Score (DWI-ASPECTS) is a rapid and practical score used for quantifying the extent of early ischemic changes in acute ischemic stroke. It is strongly associated with stroke prognosis. The present study aimed to identify the main clinical, laboratory, and radiological features influencing DWI-ASPECTS in stroke patients with middle cerebral artery (MCA) occlusion.

This retrospective study evaluated a cohort of patients with stroke due to MCA occlusion who underwent magnetic resonance imaging before thrombectomy. Clinical, laboratory, and imaging data were collected. Univariate and multivariable analyses were performed to assess associations with DWI-ASPECTS.

A total of 501 patients were selected. In the univariate analysis, a lower DWI-ASPECTS was associated with younger age, male sex, smoking, no atrial fibrillation, higher admission diastolic pressure, higher leukocyte count, lower activated partial thromboplastin time (aPTT), unknown onset time, FLAIR positivity, M1 occlusion, and internal carotid occlusion; a lower oxygen saturation was observed in patients with lower DWI-ASPECTS. Multivariable analysis confirmed the association of DWI-ASPECTS with age, sex, oxygen saturation, diastolic pressure, aPTT, unknown onset time, and FLAIR positivity.

Our study shed light on several clinical, laboratory, and radiological factors influencing DWI-ASPECTS: age, sex, oxygen saturation, diastolic pressure, aPTT, unknown onset time, and FLAIR positivity. The present analysis was the first study to associate aPTT and oxygen saturation with DWI-ASPECTS. Both aPTT and oxygen saturation are modifiable factors that may represent potential targets to reduce ischemic damage and improve stroke prognosis.

The online version contains supplementary material available at 10.1007/s10072-026-08903-x.

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