Endovascular Thrombectomy in Patients With Very Low ASPECTS Scores: A Systematic Review and Meta-analysis

Randomized controlled trials (RCTs) have recently established the benefit of endovascular thrombectomy (EVT) in patients with large infarct core on baseline neuroimaging. We evaluated the utility of EVT in patients with very large infarct core, defined as Alberta Stroke Program Early CT scores (ASPECTS) of less than 3.

We performed a systematic review and meta-analysis of the subgroups of patients with baseline ASPECTS scores 0-2 included in RCTs evaluating the utility of EVT in the setting of a large infarct core. The outcome of interest was the probability of three-month functional improvement assessed with the generalized odds ratios (ORs) of the modified Rankin Scale (mRS) scores between patients receiving EVT and medical management.

In the pooled analyses of 82 participants of the total 808 (10%) enrolled in 2 individual trials, we found a statistically significant shift in the distribution of mRS scores toward better outcomes in favor of EVT (generalized OR 1.46, 95% CI 1.03-2.07). No evidence of heterogeneity was detected (I ² = 0%; p for Cochran Q = 0.73).

The results from our pooled analysis challenge the exclusion of patients presenting with ASPECTS scores less than 3 from receiving EVT if they are otherwise eligible.