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Interaction between time, ASPECTS, and clinical mismatch.

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Summary
This summary is machine-generated.

Clinical-core mismatch (CCM) is prevalent in large vessel occlusion (LVO) strokes, particularly with higher ASPECTS scores. Mismatch likelihood decreases with time and lower ASPECTS, supporting ASPECTS-based selection for late-window neurothrombectomy.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Neurothrombectomy patient selection relies on differentiating irreversible (core) and salvageable (penumbra) brain tissue.
  • The DAWN trial utilized the clinical-core mismatch (CCM) paradigm, defined by clinical deficit disproportionate to infarct volume.

Purpose of the Study:

  • To determine the prevalence of CCM in large vessel occlusion (LVO) strokes.
  • To investigate the impact of time and Alberta Stroke Program Early CT Score (ASPECTS) on CCM likelihood.

Main Methods:

  • Retrospective analysis of 185 LVO strokes with advanced imaging (relative cerebral blood flow/MRI).
  • Automated software used for infarct volume and ASPECTS determination.
  • Analysis of CCM prevalence, time, and ASPECTS impact.

Main Results:

  • CCM was present in 53% of LVO strokes within 0-24 hours, decreasing by 1.6% per hour.
  • Mismatch prevalence was 77% for ASPECTS 9-10, 65% for ASPECTS 6-8, and 13% for ASPECTS 0-5.
  • Higher ASPECTS independently predicted CCM (OR 1.4), and mismatch did not decline over time within ASPECTS groups.

Conclusions:

  • CCM is present in 57% (0-6 hours) and 50% (6-24 hours) of LVO strokes.
  • Mismatch prevalence decreases with time and lower ASPECTS.
  • ASPECTS-based patient selection is supported for late-window neurothrombectomy.