{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:32:46Z","timestamp":1792031566320,"version":"4.4.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The extent of ischemic injury in acute stroke is assessed in clinical practice using the Acute Stroke Prognosis Early CT Score (ASPECTS) rating system. However, current ASPECTS semi-quantitative topographic scales assess only the middle cerebral artery (MCA) (original ASPECTS) and posterior cerebral (PC-ASPECTS) territories. For treatment decision-making in patients with anterior cerebral artery (ACA) occlusions and internal carotid artery (ICA) occlusions with large ischemic cores, measures of all hemispheric regions are desirable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cohort study, anatomic rating systems were developed for the anterior cerebral (AC-ASPECTS, 3 points) and anterior choroidal artery (ACh-ASPECTS, 1 point) territories. In addition, a total supratentorial hemisphere (H-ASPECTS, 16 points) score was calculated as the sum of the MCA ASPECTS (10 regions), supratentorial PC-ASPECTS (2 regions), AC-ASPECTS (3 regions), and ACh-ASPECTS (1 region). Three raters applied these scales to initial and 24\u2009h CT and MR images in consecutive patients with ischemic stroke (IS) due to ICA, M1-MCA, and ACA occlusions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Imaging ratings were obtained for 96 scans in 50 consecutive patients with age 74.8 (\u00b114.0), 60% female, NIHSS 15.5 (9.25\u201320), and occlusion locations ICA 34%; M1-MCA 58%; and ACA 8%. Treatments included endovascular thrombectomy +\/\u2212 thrombolysis in 72%, thrombolysis alone in 8%, and hemicraniectomy in 4%. Among experienced clinicians, inter-rater reliability for AC-, ACh-, and H-ASPECTS scores was substantial (kappa values 0.61\u20130.80). AC-ASPECTS abnormality was present in 14% of patients, and ACh-ASPECTS abnormality in 2%. Among patients with ACA and ICA occlusions, H-ASPECTS scores compared with original ASPECTS scores were more strongly associated with disability level at discharge, ambulatory status at discharge, discharge destination, and combined inpatient mortality and hospice discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>AC-ASPECTS, ACh-ASPECTS, and H-ASPECTS expand the scope of acute IS imaging scores and increase correlation with functional outcomes. This additional information may enhance prognostication and decision-making, including endovascular thrombectomy and hemicraniectomy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1397120","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T05:22:46Z","timestamp":1719984166000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["AC-ASPECTS, ACh-ASPECTS, and H-ASPECTS: new imaging scales to assess territorial and total cerebral hemispheric ischemic injury"],"prefix":"10.3389","volume":"15","author":[{"given":"Maria Paz","family":"Rodriguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayandokht","family":"Taleb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny Ji-hyun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Saver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e922","DOI":"10.1212\/WNL.0000000000207536","article-title":"Mechanical Thrombectomy for large ischemic stroke: a systematic review and meta-analysis","volume":"101","author":"Li","year":"2023","journal-title":"Neurology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/S1474-4422(16)30196-X","article-title":"Safety and efficacy of intravenous glyburide on brain swelling after large hemispheric infarction (GAMES-RP): a randomised, double-blind, placebo-controlled phase 2 trial","volume":"15","author":"Sheth","year":"2016","journal-title":"Lancet Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s00415-020-10358-9","article-title":"Strokectomy for malignant middle cerebral artery infarction: experience and meta-analysis of current evidence","volume":"269","author":"Moughal","year":"2022","journal-title":"J Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"594289","DOI":"10.3389\/fneur.2020.594289","article-title":"Selective brain hypothermia in acute ischemic stroke: reperfusion without reperfusion injury","volume":"11","author":"Choi","year":"2020","journal-title":"Front Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1007\/s12028-019-00782-9","article-title":"What is the role of hyperosmolar therapy in hemispheric stroke patients?","volume":"32","author":"Mohney","year":"2020","journal-title":"Neurocrit Care"},{"key":"ref6","first-page":"1534","article-title":"Use of the Alberta stroke program early CT score (ASPECTS) for assessing CT scans in patients with acute stroke","volume":"22","author":"Pexman","year":"2001","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"175628642211396","DOI":"10.1177\/17562864221139632","article-title":"Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis","volume":"15","author":"Safouris","year":"2022","journal-title":"Ther Adv Neurol Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1056\/NEJMoa2118191","article-title":"Endovascular therapy for acute stroke with a large ischemic region","volume":"386","author":"Yoshimura","year":"2022","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1056\/NEJMoa2213379","article-title":"Trial of endovascular therapy for acute ischemic stroke with large infarct","volume":"388","author":"Huo","year":"2023","journal-title":"N Engl J Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1056\/NEJMoa2214403","article-title":"Trial of endovascular Thrombectomy for large ischemic strokes","volume":"388","author":"Sarraj","year":"2023","journal-title":"N Engl J Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/s0140-6736(00)02237-6","article-title":"Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. 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