Abstract TP298: ASPECTS as a Predictor of Intracerebral Hemorrhage Following Endovascular Therapy for Anterior Circulation Stroke: an independent patient data meta-analysis

Introduction: Despite the success of endovascular thrombectomy (EVT) for ischemic stroke, complications such as intracerebral hemorrhage (ICH) occur. In individual studies, the Alberta Stroke Program Early CT Score (ASPECTS) predicts ICH risk, but comprehensive data are lacking. We conducted a systematic review and pooled patient meta-analysis to evaluate the association between ASPECTS and ICH after EVT. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Cochrane from January 1, 2012, to July 1, 2024. We included randomized controlled trials and prospective observational studies of patients ≥18 years old with anterior circulation ischemic stroke on CT, CTP, or DWI-MRI who underwent EVT within 24h of symptoms onset. The primary outcome was the association between ASPECTS and symptomatic ICH; the secondary outcome was ASPECTS and any ICH. For the meta-analysis, we conducted an exploratory analysis to identify covariates for the multivariable model. Odds ratios (OR) with 95% CI were calculated, adjusting for hypertension, diabetes, National Institutes of Health Stroke Scale (NIHSS) score, time from symptoms onset to randomization, and modified Thrombolysis in Cerebral Infarction (mTICI) score. Results: A total of 3,290 studies were screened, with 31 selected for full-text review. Thirteen met inclusion criteria: 11 randomized controlled trials and 2 prospective observational studies. Symptomatic ICH rates ranged from 0–11.7%, and any ICH from 2.8–91.5%. Data from DEFUSE3, ESCAPE, ESCAPE-NA1, and IMS3 were included in the patient-level meta-analysis, comprising a total of 1,182 patients. A 1-point lower ASPECT score was not associated with higher odds of symptomatic ICH (OR 1.01; 95% CI 0.90, 1.14; p=0.84) but was associated with higher odds of any ICH (OR 1.19; 95% CI 1.12, 1.27; p<0.0001). Compared with ASPECT score 9–10, categories 6–8, 3–5, and 0–2 were all associated with increased odds of any ICH (Table 1). Conclusion: In this patient-level meta-analysis, a lower ASPECT score was significantly associated with higher odds of any ICH, but not symptomatic ICH. These findings provide important information on complications in patients with larger stroke burden treated with EVT.