ASPECTS, Large Vessel Occlusion, and Time of Symptom Onset: Estimation of Eligibility for Endovascular Therapy
Related Experiment Video
Updated: Feb 19, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Maxim Mokin1, Aparna Pendurthi1, Vladimir Ljubimov1
1Department of Neurology and Neurosurgery, University of South Florida, Tampa, Florida.
Insights
Eligibility for endovascular therapy in acute ischemic stroke patients with large vessel occlusion (LVO) varies significantly. Between 4% and 20% of LVO patients may be candidates, depending on specific selection criteria used for stroke care.
Area of Science:
- Neurology
- Interventional Cardiology
- Public Health
Background:
- Effective stroke systems of care rely on accurate patient selection for advanced treatments.
- Endovascular therapy offers a critical treatment option for acute ischemic stroke patients with large vessel occlusion (LVO).
Purpose of the Study:
- To determine the proportion of acute ischemic stroke patients with LVO eligible for endovascular therapy.
- To analyze the impact of varying selection criteria on treatment eligibility.
Main Methods:
- Retrospective cohort study of acute ischemic stroke patients with LVO (January 2014 - December 2015).
- Applied selection criteria including LVO location, Alberta Stroke Program Early CT Score (ASPECTS), hospital arrival time, and IV thrombolysis use.
- Calculated eligibility proportions based on Class I (Level A) and less restrictive (Class IIb, Level C) guidelines.
Main Results:
- Of 989 stroke patients, 224 (23%) had LVO.
- Favorable ASPECTS (≥6) for thrombectomy were observed in 84% admitted within 6h, 75% within 6-12h, and 77% within 12-24h (M1/ICA occlusions).
- Using restrictive criteria (Class I), 4% of LVO patients were eligible; with less restrictive criteria (Class IIb), eligibility rose to 20%.
Conclusions:
- Patient eligibility for endovascular therapy in LVO stroke varies widely based on applied selection criteria.
- Eligibility ranged from 4% under stringent guidelines to 20% under more lenient criteria.
- These findings are crucial for optimizing stroke care pathways and resource allocation.
Background:
Understanding how many patients are eligible for endovascular therapy can help develop more effective stroke systems of care.
Objective:
To determine the proportion of patients eligible for endovascular therapy.
Methods:
In this single center retrospective cohort study, we identified patients with acute ischemic stroke from large vessel occlusion (LVO) from January 2014 to December 2015. Selection criteria including LVO location, Alberta stroke program early computed tomography score (ASPECTS) range, hospital arrival time, and the use of intravenous thrombolysis were applied to calculate proportions of patients eligible for endovascular therapy.
Results:
Of 989 patients with acute ischemic stroke, LVO was identified in 224 (23%) cases. Eighty-four percent of patients admitted within 6 h, 75% of patients admitted within 6 to 12 h, and 77% of patients with M1 and internal carotid artery occlusions admitted within 12 to 24 h had favorable ASPECTS for thrombectomy, defined as ASPECTS ≥ 6. Severity of NIHSS (National Institutes of Health Stroke Scale) was predictive of favorable ASPECTS (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.04-0.74; P = .014 for NIHSS > 10 and OR 0.30, 95% CI 0.12-0.80; P = .014 for NIHSS > 20), whereas time of hospital arrival was not (OR 1.73, 95% CI 0.76-4.03; P = .26). Using all class I, Level of Evidence A American Heart Association guidelines criteria, 4% of patients with acute ischemic stroke were eligible for endovascular therapy. Up to 20% of patients were eligible for endovascular therapy with less restrictive criteria (Class IIb; Level of Evidence C).
Conclusion:
Depending on the sets of selection criteria, between 4% (the most restrictive criteria) and 20% (the least restrictive criteria) of patients with LVO are potentially eligible for endovascular therapy.
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