A retrospective cohort study was performed to determine the likelihood of malignant stroke after mechanical thrombectomy via a novel scoring scale using ASPECT score and number of arterial-passes. This prediction score is designed to help clinicians take early measures. 

We performed a retrospective cohort analysis on 80 patients with anterior circulation stroke who underwent mechanical thrombectomy at our hospital. We analyzed the likelihood of developing malignant stroke post thrombectomy in the first 5 days following successful recanalization (TICI >2b).  Malignant stroke is defined as severe symptoms secondary to edema as evidenced by midline shift, cistern engorgement, and hemorrhagic conversion. Patients with ASPECT 0-5 were excluded.

We used two variables to predict the outcome: ASPECT score and number-of-passes. We used the equation ASPECT score minus number-of-passes (A-P) to arrive at a single number to predict the risk of malignant stroke. A-P scoring scale ranged from 0-9. We used logistic regression for statistical analysis. Other variables (door-to-groin time, groin-to-first pass, and recanalization) were adjusted.