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ASPECTS Score
Quantify early ischemic changes on non-contrast CT in MCA territory strokes. Guides tPA and thrombectomy eligibility.
Indication
- Quantify early ischemic changes on non-contrast CT in MCA territory strokes. Guides tPA and thrombectomy eligibility.
Criteria
- id: c; label: C — Caudate; type: yesno; points: 1
- id: l; label: L — Lentiform nucleus; type: yesno; points: 1
- id: ic; label: IC — Internal capsule; type: yesno; points: 1
- id: insula; label: I — Insular ribbon; type: yesno; points: 1
- id: m1; label: M1 — Anterior MCA cortex; type: yesno; points: 1
- id: m2; label: M2 — MCA cortex lateral to insula; type: yesno; points: 1
- id: m3; label: M3 — Posterior MCA cortex; type: yesno; points: 1
- id: m4; label: M4 — Anterior MCA superior to M1; type: yesno; points: 1
- id: m5; label: M5 — Lateral MCA superior to M2; type: yesno; points: 1
- id: m6; label: M6 — Posterior MCA superior to M3; type: yesno; points: 1
Clinical pearls
- ASPECTS ≤5 generally contraindicates tPA due to high hemorrhagic transformation risk and poor outcomes
- DAWN and DEFUSE-3 used ASPECTS ≥6 as an inclusion criterion for late-window thrombectomy
- Interrater reliability improves significantly with CT perfusion imaging
- Score is for MCA territory — it does not apply to posterior circulation strokes
Source and review
- Barber PA et al. Lancet 2000; DAWN and DEFUSE-3 inclusion criteria. Last reviewed: 2025-01-01