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ASPECT Score for

Assessment in Acute Stroke

  • Alberta Stroke Program Early CT score (ASPECTS) is a 10-point quantitative score used to assess early ischemic changes on non-contrast CT head.
  • ASPECTS is intended to provide a reliable and reproducible grading system on non-contrast CT examinations of the head for detection of early ischemic changes in patients suspected of having acute large vessel anterior circulation occlusion. It is used as part of the assessment for eligibility in receiving interventional mechanical thrombectomy treatment.
  • ASPECTS score is a simple and reliable tool for detection of early ischemic changes on non-contrast CT scans of the brain.


Easily Applicable

Easily Applicable

Based on the Plain/Non-contrast CT Head. The ASPECT Score can be used to assess early ischemic changes in acute stroke on any modern CT scanner without the need for additional processing steps making it easily applicable in many settings worldwide.

Imaging Based

Imaging Based

As the initial imaging modality to both screen for and establish the diagnosis of acute stroke, the ASPECT Score provides an opportunity to quantify the degree of ischemic changes in the brain parenchyma and serve as the basis for subsequent decision making. 

Easily Communicated

Easily Communicated

A score out of 10, the ASPECT Score is an easy and widely understood means of communicating the extent of ischemic changes amongst care teams and physicians.

Learn to Calculate the ASPECT Score:

ASPECTS Training Course and Certificate Info:

The educational modules (EdModules) will take you through basics of the clinical presentation, imaging, and initial assessment of acute stroke on CT scans with insights on how to determine early ischemic changes and the ASPECT Score. Subsequent modules will focus on multiphase CTA (mCTA)  and assessment of the collateral circulation

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Acute Stroke Case Reports:


    Latest Research and Publications:

    Workflow patterns and potential for optimization in endovascular stroke treatment across the world: results from a multinational survey.

    Icon for HighWire Related Articles

    Workflow patterns and potential for optimization in endovascular stroke treatment across the world: results from a multinational survey.

    J Neurointerv Surg. 2020 Apr 06;:

    Authors: Ospel JM, Almekhlafi MA, Menon BK, Kashani N, Chapot R, Fiehler J, Hassan AE, Yavagal D, Majoie CBLM, Jayaraman MV, Hill MD, Goyal M

    BACKGROUND: The benefit of endovascular treatment (EVT) is highly time-dependent, and treatment delays reduce patients' chances to achieve a good outcome. In this survey-based study, we aimed to evaluate current in-hospital EVT workflow characteristics across different countries and hospital settings, and to quantify the time-savings that could be achieved by optimizing particular workflow steps.
    METHODS: In a multinational survey, neurointerventionalists were asked to provide specific information about EVT workflows in their current working environment. Workflow characteristics were summarized using descriptive statistics and stratified by country and physician characteristics, such as age, career stage, personal and institutional caseload.
    RESULTS: Among 248 respondents from 48 countries, pre-notification of the neurointerventional team was used in 70% of cases. The emergency department (ED) and CT scanner, and the CT scanner and neuroangiography suite, were on different floors in 23% and 38%, respectively. Redundant procedures in the ED were often routinely performed, such as chest x-rays (in 6%). General anesthesia was the most frequently used anesthesia protocol for EVT (42%), and an anesthesiologist was available in 82% for this purpose. 52% of the participants used a pre-prepared EVT kit.
    CONCLUSION: The current structure of EVT workflows offers possibilities for improvement. While some bottlenecks, such as the spatial department set-up, cannot easily be resolved, pre-notification tools and pre-prepared EVT kits are more straightforward to implement and could help to reduce treatment delays, and thereby improve patient outcomes.

    PMID: 32253281 [PubMed - as supplied by publisher]

    Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial.

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    Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial.

    Lancet. 2020 03 14;395(10227):878-887

    Authors: Hill MD, Goyal M, Menon BK, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Buck BH, Field TS, Dowlatshahi D, van Adel BA, Swartz RH, Shah RA, Sauvageau E, Zerna C, Ospel JM, Joshi M, Almekhlafi MA, Ryckborst KJ, Lowerison MW, Heard K, Garman D, Haussen D, Cutting SM, Coutts SB, Roy D, Rempel JL, Rohr AC, Iancu D, Sahlas DJ, Yu AYX, Devlin TG, Hanel RA, Puetz V, Silver FL, Campbell BCV, Chapot R, Teitelbaum J, Mandzia JL, Kleinig TJ, Turkel-Parrella D, Heck D, Kelly ME, Bharatha A, Bang OY, Jadhav A, Gupta R, Frei DF, Tarpley JW, McDougall CG, Holmin S, Rha JH, Puri AS, Camden MC, Thomalla G, Choe H, Phillips SJ, Schindler JL, Thornton J, Nagel S, Heo JH, Sohn SI, Psychogios MN, Budzik RF, Starkman S, Martin CO, Burns PA, Murphy S, Lopez GA, English J, Tymianski M, ESCAPE-NA1 Investigators

    BACKGROUND: Nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, is a neuroprotectant that is effective in preclinical stroke models of ischaemia-reperfusion. In this trial, we assessed the efficacy and safety of nerinetide in human ischaemia-reperfusion that occurs with rapid endovascular thrombectomy in patients who had an acute ischaemic stroke.
    METHODS: For this multicentre, double-blind, randomised, placebo-controlled study done in 48 acute care hospitals in eight countries, we enrolled patients with acute ischaemic stroke due to large vessel occlusion within a 12 h treatment window. Eligible patients were aged 18 years or older with a disabling ischaemic stroke at the time of randomisation, had been functioning independently in the community before the stroke, had an Alberta Stroke Program Early CT Score (ASPECTS) greater than 4, and vascular imaging showing moderate-to-good collateral filling, as determined by multiphase CT angiography. Patients were randomly assigned (1:1) to receive intravenous nerinetide in a single dose of 2·6 mg/kg, up to a maximum dose of 270 mg, on the basis of estimated or actual weight (if known) or saline placebo by use of a real-time, dynamic, internet-based, stratified randomised minimisation procedure. Patients were stratified by intravenous alteplase treatment and declared endovascular device choice. All trial personnel and patients were masked to sequence and treatment allocation. All patients underwent endovascular thrombectomy and received alteplase in usual care when indicated. The primary outcome was a favourable functional outcome 90 days after randomisation, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary outcomes were measures of neurological disability, functional independence in activities of daily living, excellent functional outcome (mRS 0-1), and mortality. The analysis was done in the intention-to-treat population and adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, ASPECTS, occlusion location, site, alteplase use, and declared first device. The safety population included all patients who received any amount of study drug. This trial is registered with ClinicalTrials.gov, NCT02930018.
    FINDINGS: Between March 1, 2017, and Aug 12, 2019, 1105 patients were randomly assigned to receive nerinetide (n=549) or placebo (n=556). 337 (61·4%) of 549 patients with nerinetide and 329 (59·2%) of 556 with placebo achieved an mRS score of 0-2 at 90 days (adjusted risk ratio 1·04, 95% CI 0·96-1·14; p=0·35). Secondary outcomes were similar between groups. We observed evidence of treatment effect modification resulting in inhibition of treatment effect in patients receiving alteplase. Serious adverse events occurred equally between groups.
    INTERPRETATION: Nerinetide did not improve the proportion of patients achieving good clinical outcomes after endovascular thrombectomy compared with patients receiving placebo.
    FUNDING: Canadian Institutes for Health Research, Alberta Innovates, and NoNO.

    PMID: 32087818 [PubMed - indexed for MEDLINE]

    Discrepancies between current and ideal endovascular stroke treatment practice in Europe and North America: Results from UNMASK EVT, a multidisciplinary survey.

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    Discrepancies between current and ideal endovascular stroke treatment practice in Europe and North America: Results from UNMASK EVT, a multidisciplinary survey.

    Interv Neuroradiol. 2020 Feb 20;:1591019920908131

    Authors: Ospel JM, Kashani N, Turjman F, Fischer U, Baxter B, Rabinstein A, Coutts S, Menon BK, Almekhlafi M, Hill MD, Saposnik G, Goyal M

    BACKGROUND: Since 2015, endovascular therapy has been established as a standard of care for acute stroke. This has caused major challenges regarding the organization of systems of care, which have to meet the increasing demand for thrombectomies. This study aims to evaluate how endovascular therapy decisions made by European and North American physicians under their current local resources differ from those made under assumed ideal conditions.
    METHODS: In an international, multidisciplinary survey, physicians involved in acute stroke care were asked to give their treatment decisions to 10 out of 22 randomly assigned stroke case-scenarios. Participants stated (a) their treatment approach under assumed ideal conditions (without any external limitations) and (b) the treatment they would pursue under their current local resources. Resources gaps (ideal minus current endovascular therapy rates) were calculated for different countries/states/provinces and correlated to economic and healthcare key metrics (gross domestic product-per-capita, public or private health insurance coverage, etc.).
    RESULTS: A total of 607 physicians, among them 218 from North America and 136 from 25 European countries, responded to the survey. Resources gaps in the majority of North American states/provinces and European countries were small (<5%). The highest gaps were observed among few European countries, namely Poland (30%) and the United Kingdom (33%). The magnitude of the resources gap did not correlate to national economic or healthcare metrics.
    DISCUSSION AND CONCLUSION: In the majority of North American states/provinces and European countries covered in this study, the discrepancy between endovascular therapy decisions under current local resources and assumed ideal conditions seems to be small, even in countries with a limited economic status and healthcare infrastructure.

    PMID: 32077353 [PubMed - as supplied by publisher]

    Endovascular treatment decision-making in acute ischemic stroke patients with large vessel occlusion and low National Institutes of Health Stroke Scale: insights from UNMASK EVT, an international multidisciplinary survey.

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    Endovascular treatment decision-making in acute ischemic stroke patients with large vessel occlusion and low National Institutes of Health Stroke Scale: insights from UNMASK EVT, an international multidisciplinary survey.

    Neuroradiology. 2020 Feb 15;:

    Authors: Ospel JM, Kim B, Heo JH, Yoshimura S, Kashani N, Menon B, Almekhlafi M, Demchuk A, Hill M, Saposnik G, Goyal M

    PURPOSE: Many stroke patients with large vessel occlusion present with a low National Institutes of Health Stroke Scale (NIHSS). There is currently no level 1A recommendation for endovascular treatment (EVT) for this patient subgroup. From a physician's standpoint, the deficits might only be slight, but they are often devastating from a patient perspective. Furthermore, early neurologic deterioration is common. The purpose of this study was to explore endovascular treatment attitudes of physicians in acute ischemic stroke patients presenting with low admission NIHSS.
    METHODS: In an international cross-sectional survey among stroke physicians, participants were presented the scenario of a 76-year-old stroke patient with an admission NIHSS of 2. Survey participants were then asked how they would treat the patient (A) given their current local resources, and (B) under assumed ideal conditions, i.e., without external (monetary or infrastructural) constraints. Overall, country-specific and specialty-specific decision rates were calculated and clustered multivariable logistic regression performed to provide adjusted measures of effect size.
    RESULTS: Two hundred seventy-five participants (150 neurologists, 84 interventional neuroradiologists, 30 neurosurgeons, 11 affiliated to other specialties) from 33 countries provided their treatment approach to this case scenario. Most physicians favored an endovascular treatment approach, either combined with intravenous alteplase (55.3% under assumed ideal and 52.0% under current working conditions) or as single treatment (11.3% under assumed ideal and 8.4% under current conditions).
    CONCLUSION: Despite the limited evidence for endovascular therapy in acute stroke patients with low NIHSS, most physicians in this survey decided to proceed with endovascular therapy. A randomized controlled trial seems warranted.

    PMID: 32060567 [PubMed - as supplied by publisher]