Impact of Corticospinal Tract Involvement Beyond ASPECTS on Brain Imaging Prior to Endovascular Therapy in Patients...

The Alberta Stroke Program Early Computed Tomography Score and core volume on preoperative imaging are key predictors of clinical outcomes following endovascular therapy in patients with a large ischemic core. Although the corticospinal tract is essential for motor function, its prognostic impact in patients with a large ischemic core remains unclear.

This multicenter retrospective study analyzed preoperative imaging data from patients with Alberta Stroke Program Early Computed Tomography Score ≤5 who underwent endovascular therapy. The presence of lesions in the posterior corona radiata and lesions in the primary motor cortex was assessed. A good outcome was defined as a modified Rankin Scale score ≤3 at 90 days. The association between lesions in the posterior corona radiata, lesions in the primary motor cortex, and good outcome was analyzed using univariable and stepwise multivariable logistic regression, with variable selection based on Akaike information criterion corrected for small sample size.

Among 107 patients, 37 (34.6%) achieved a good outcome. In univariable analysis, neither lesions in the posterior corona radiata nor core volume was significantly associated with a good outcome. In stepwise multivariable logistic regression, modified Rankin Scale score before onset (odds ratio, 0.30 [95% CI, 0.10-0.73]), cardioembolism (odds ratio, 0.25 [95% CI, 0.08-0.76]), absence of lesions in the primary motor cortex involvement (odds ratio, 13.49 [95% CI, 3.75-63.45]), and shorter onset-to-reperfusion time (odds ratio, 0.996 [95% CI, 0.992-0.998]) were independent predictors. Alberta Stroke Program Early Computed Tomography Score and the absence of multiple artery occlusion were retained in the final model but were not statistically significant.

Absence of lesions in the primary motor cortex involvement was independently associated with good outcome after endovascular therapy in patients with large ischemic core, suggesting its potential utility as a complementary imaging marker in this population.