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Abstract: Background: Baseline Alberta Stroke Program Early CT Score (ASPECTS) is widely used to estimate infarct burden in acute ischemic stroke, but its prognostic value may vary by age. We evaluated whether the relationship between baseline ASPECTS and 90-day functional outcome differs across age groups in patients undergoing mechanical thrombectomy (MT). Methods: We retrospectively analyzed consecutive patients at a single comprehensive stroke center from 2022-2025 with anterior circulation AIS-LVO treated with MT. Patients were stratified by age: <65, 65-79, and ≥80 years. The primary outcome measure was 90-day modified Rankin Scale (mRS 0-6); secondary outcome was good functional outcome (mRS 0-2 vs 3-6). Each patient’s preprocedural CT was independently reviewed and an adjudicated ASPECTS was reported. Differences in mRS were assessed using ANOVA and Kruskal-Wallis tests; good outcome rates were compared using chi-square. Within each age group, linear regression evaluated associations between ASPECTS and mRS. Logistic regression identified predictors of good outcome, and interaction testing assessed whether the ASPECTS-outcome relationship varied by age. Polynomial modeling assessed whether quadratic age terms improved model fit, and exploratory decade-based analyses assessed age-matched ASPECTS thresholds. Results: A total of 700 patients were included. Functional outcomes differed significantly across age groups (ANOVA p<0.001; Kruskal-Wallis p<0.001), with declining rates of good outcome (chi-square p<0.001): <65 (51.1%), 65-79 (37.6%), and ≥80 (18.4%). Higher ASPECTS increased odds of good outcome overall (OR 1.44, p<0.001). A significant ASPECTS-by-age interaction (p=0.005) indicated age-dependent prognostic effects, strongest in the ≥80 group (OR 2.01, p<0.001). The continuous ASPECTS-mRS interaction was not significant (p=0.211), but quadratic age modeling fit better than linear age modeling in both unadjusted and adjusted analyses (both LRT p<0.001). Exploratory decade-based threshold analysis showed marked outcome separation above versus below age-matched ASPECTS thresholds in the 60s through 80s, including 1.9% versus 40.0% in the 80-89 decade, whereas patients aged 90 years or older had poor outcomes overall with limited threshold separation (2.3% vs 8.0%). Conclusions: Baseline ASPECTS demonstrates age-dependent prognostic value for 90-day outcomes after MT, and the relationship is better characterized by a nonlinear age model than by a simple linear decline. The prognostic effect was strongest in the oldest patients, and exploratory threshold analysis suggests that older thrombectomy candidates may be less tolerant of larger ischemic core volumes, supporting age-adapted interpretation of ASPECTS after further validation.
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Identifier: DOI: 10.26300/8y28-jj31