{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:47:09Z","timestamp":1782820029837,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In acute stroke due to a large vessel occlusion (AIS-LVO), identifying a core-perfusion mismatch guides reperfusion therapy in extended time window, but perfusion imaging is not universally available. We investigated whether the Alberta Stroke Program Early CT Score (ASPECTS) is associated with core-perfusion mismatch and could serve as a surrogate imaging marker.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We retrospectively analysed a large multicentre international unselected cohort of consecutive AIS-LVO patients imaged between 4.5 and 24\u00a0h from last time seen well, with baseline CT- or MR-perfusion imaging. Core-perfusion mismatch was defined as a mismatch volume\u00a0\u2265\u00a015\u00a0mL and a mismatch ratio\u00a0\u2265\u00a01.8 using automated software. CT and MRI cohorts were analysed separately.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 531 included patients, 182 underwent CT and 349 MRI. Core-perfusion mismatch was present in 86% of CT patients and 62% of MRI patients. Alberta Stroke Program Early CT Score was strongly associated with mismatch in both cohorts (P\u00a0&amp;lt;\u00a0.001). In the MRI cohort, ASPECTS predicted mismatch with an area under the receiver operating characteristic curve (AUC) of 0.843 (95% CI, 0.797\u20130.890), with an optimal cutoff \u2265 6, yielding sensitivity 0.87, specificity 0.72, positive predictive value (PPV) 0.84 and negative predictive value (NPV) 0.77. In the CT cohort, the AUC was 0.801 (95% CI, 0.698\u20130.904), with an optimal cutoff \u2265 7, yielding sensitivity 0.74, specificity 0.81, PPV 0.96 and NPV 0.34.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The high PPV of ASPECTS \u2265 6 on MRI and ASPECTS \u2265 7 on CT supports their potential use as pragmatic enrichment criteria for patient selection in future late-window AIS-LVO trials, when perfusion imaging is unavailable, as surrogate markers of salvageable tissue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag065","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T15:17:54Z","timestamp":1780931874000},"source":"Crossref","is-referenced-by-count":0,"title":["ASPECTS as a surrogate marker of core-perfusion mismatch in late-window large vessel occlusion stroke"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2134-0691","authenticated-orcid":false,"given":"Pierre","family":"Seners","sequence":"first","affiliation":[{"name":"Neurology Department, H\u00f4pital Fondation A. de Rothschild, FHU NeuroVasc 2030 , Paris ,","place":["France"]},{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Turc, \u00a0 Paris 75014 ,","place":["France"]},{"name":"Stroke-Link F-CRIN Research Network , Lille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Yuen","sequence":"additional","affiliation":[{"name":"Stanford Stroke Center , Stanford, CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4429-2714","authenticated-orcid":false,"given":"Davide","family":"Strambo","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Carrera","sequence":"additional","affiliation":[{"name":"Neurology Department, Geneva University Hospitals , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam R","family":"Heldner","sequence":"additional","affiliation":[{"name":"Neurology Department, Inselspital, Bern University Hospital, University of Bern , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Olivot","sequence":"additional","affiliation":[{"name":"Stroke-Link F-CRIN Research Network , Lille ,","place":["France"]},{"name":"Acute Stroke Unit, H\u00f4pital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, Inserm, UPS , Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mlynash","sequence":"additional","affiliation":[{"name":"Stanford Stroke Center , Stanford, CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy J","family":"Heit","sequence":"additional","affiliation":[{"name":"Radiology Department, Stanford University , Palo Alto, CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7757-4967","authenticated-orcid":false,"given":"Elisabeth","family":"Dirren","sequence":"additional","affiliation":[{"name":"Neurology Department, Geneva University Hospitals , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-7579","authenticated-orcid":false,"given":"Patrik","family":"Michel","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4287-2627","authenticated-orcid":false,"given":"Christophe","family":"Cognard","sequence":"additional","affiliation":[{"name":"Stroke-Link F-CRIN Research Network , Lille ,","place":["France"]},{"name":"Neuroradiology Department, Toulouse University Hospital , Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Savatovsky","sequence":"additional","affiliation":[{"name":"Radiology Department, H\u00f4pital Fondation A. de Rothschild , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Almiri","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Hospital and University of Bern , Bern 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