A CT-based assessment tool shows that recanalization is an effective way to preserve functional outcomes long term in stroke patients -- even at later time windows after the event, German researchers have reported.
The tool, called the Alberta Stroke Program Early CT Score (ASPECTS), is a 10-point scale that uses data from a baseline noncontrast CT scan to evaluate the extent of the infarction; scores under 5 indicate a larger infarct area. A group led by Dr. Gabriel Broocks of University Medical Center Hamburg-Eppendorf found that patients with low ASPECTS scores (3 to 5) responded well to vessel recanalization for up to almost 18 hours after stroke onset -- a much longer timeframe than typically assumed. The research was published on 14 October in JAMA Network Open.
"The findings of this study suggest that endovascular treatment for patients with ischemic stroke and extensive signs of infarction who present in the extended time window was associated with better functional outcomes," the group noted.
The efficacy of ASPECTS for helping to determine how best to treat stroke patients has been under consideration recently. In fact, earlier this month, Japanese researchers published findings that showed ASPECTS can help clinicians evaluate the scope of damage and determine whether the patient will benefit from endovascular treatment. But other research has not definitively shown how patients with lower ASPECTS scores -- and thus, larger infarct areas -- respond to treatment after longer times post-stroke, Broocks and colleagues wrote.
The team conducted a study that included 285 patients enrolled in the German Stroke Registry-Endovascular Treatment trial between July 2015 and December 2019 who presented between six and 24 hours after onset of the stroke, underwent CT and were determined to have an ASPECTS score of 5 or less, and had endovascular treatment. Primary outcome for the research was a modified Rankin Scale (mRS) score of 3 or less 90 days after the stroke event, indicating successful recanalization (i.e., restored flow to the affected brain vessels) via endovascular treatment. According to mRS scoring, lower scores correlate to better patient outcomes.
Of the study cohort, 28% had an mRS score of 3 or less at 90 days post-stroke, and this was more common among patients with successful recanalization than those without. The overall rate of functional independence among the study cohort at 90 days post stroke was 20%.
Successful revascularization among stroke patients with low ASPECTS scores translated to better outcomes (measured by mRS score).
| Recanalization outcomes in patients with mRS score of 3 at 90-days post-stroke | |||
| Measure | Unsuccessful recanalization | Successful recanalization | |
| Favorable overall | 13% | 32% | |
| Functional independence overall | 9% | 23% | |
| Functional independence among patients older than 75 | 11% | 16% | |
The study findings are good news for stroke sufferers.
"[Our study] revealed [that] the rate of favorable outcomes after successful endovascular recanalization among this patient cohort was similar to previously reported outcomes among patients with low ASPECTS in the early time window, suggesting that patients with large core infarcts may benefit even in the extended time window," the authors concluded.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
