{
  "abstract": "Background Acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a severe and often life-threatening condition. Mechanical thrombectomy (MT) is the standard of care for eligible patients; however, clinical outcomes vary considerably, particularly with increasing age. Despite similar technical success rates, older patients consistently demonstrate higher mortality and lower rates of functional independence.Baseline non-contrast CT (NCCT)–derived Alberta Stroke Program Early CT Score (ASPECTS) is routinely used to estimate infarct burden and guide patient selection. While both advanced age and lower ASPECTS independently predict worse outcomes, whether the prognostic implications of a given ASPECTS differ across the age spectrum remains unclear. As MT expands into older populations, understanding age-specific imaging thresholds is increasingly clinically relevant. We evaluated how baseline NCCT-ASPECTS predicts 90-day functional outcomes across age strata in patients with anterior circulation AIS-LVO undergoing MT.Methods We retrospectively analyzed 147 patients treated with MT for AIS-LVO. Patients were stratified by age: <65, 65–79, and ≥80 years. ASPECTS was independently adjudicated for all patients by two readers in consensus. The primary outcome was 90-day modified Rankin Scale (mRS, 0–6). Secondary outcome was good functional outcome (mRS 0–2 vs 3–6). Differences in mRS across age groups were assessed using ANOVA and Kruskal-Wallis testing. Good outcome distribution was compared using chi-square analysis. Linear regression evaluated associations between baseline ASPECTS and mRS. Logistic regression assessed predictors of good functional outcome, and interaction testing evaluated whether the ASPECTS–outcome relationship differed by age group.Results Functional outcomes differed significantly across age groups (p<0.001). Rates of good functional outcome (mRS 0–2) declined progressively with age (p<0.001). Pairwise comparisons demonstrated significantly worse outcomes in patients aged ≥80 compared to both younger groups. Higher baseline ASPECTS was associated with lower 90-day mRS. Both age and ASPECTS independently predicted outcome in multivariable models.While the ASPECTS-continuous mRS association did not significantly differ by age group, logistic regression demonstrated a significant interaction between age groups and ASPECTS scores for good functional outcome (p=0.027). Stratified analysis revealed age-dependent threshold behavior: among patients ≥80 years, favorable outcomes were observed only in those with ASPECTS 8–10 (0/24 good outcomes below 8), whereas younger patients demonstrated favorable outcomes across a broader ASPECTS range.Conclusion Higher baseline NCCT-ASPECTS and younger age independently predicted improved 90-day functional outcomes after MT. In this cohort, octogenarians achieved favorable outcomes only at ASPECTS values of 8-10. These findings support age-stratified interpretation of ASPECTS and warrant validation in larger cohorts.Disclosures N. Beller: None. D. Hong: None. M.R. Gonzales: None. L. Bi: None. G. Karayi: None. J. Keth: None. R. Kim: None. A. Parvaresh-Riz: None. C. Nguyen: None. M. Usher: None. J.R. Feler: None. E. Shaaya: None. R. Torabi: None. K. Moldovan: None. M. Jayaraman: None. D.N. Wolman: None.Abstract P-007 Figure 1Baseline ASPECTS and 90-day mRS across age groups. Scatterplot of baseline NCCT ASPECTS versus 90-day modified Rankin Scale (mRS, 0-6), stratified by age (<65, 65-79, 80). Lines represent within-group linear regression fits. Higher ASPECTS was associated with lower mRS across groups. Age-by-ASPECTS interaction p-value derived from logistic regression model",
  "authors": [
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "N Beller"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "D Hong"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "MR Gonzales"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "L Bi"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "G Karayi"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "J Keth"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "R Kim"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "A Parvaresh-Riz"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "C Nguyen"
    },
    {
      "affiliations": [
        "The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "M Usher"
    },
    {
      "affiliations": [
        "Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "JR Feler"
    },
    {
      "affiliations": [
        "Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "E Shaaya"
    },
    {
      "affiliations": [
        "Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "R Torabi"
    },
    {
      "affiliations": [
        "Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "K Moldovan"
    },
    {
      "affiliations": [
        "Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "M Jayaraman"
    },
    {
      "affiliations": [
        "Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI"
      ],
      "name": "DN Wolman"
    }
  ],
  "title": "P-007 Age-dependent ASPECTS thresholds for functional independence after mechanical thrombectomy in acute ischemic stroke",
  "uid": "7f083db9-7095-50db-ba27-225191f1b2cc"
}