Background: Rapid and accurate imaging assessment is critical for selecting acute ischemic stroke (AIS) patients for endovascular therapy. While CT perfusion (CTP) provides quantitative evaluation of infarct core, the ASPECTS score based on non-contrast CT (NCCT) is widely used for its speed and simplicity. However, their comparative predictive value and consistency in clinical practice remain unclear. Objective: To evaluate the prognostic value of NCCT-based ASPECTS and CTP-derived core infarct volume in AIS patients undergoing endovascular treatment, and to explore their correlation and clinical implications. Methods: In this retrospective single-center study, we analyzed 82 patients with acute ischemic stroke who underwent endovascular therapy within 24 hours of symptom onset. Preoperative ASPECTS scores and CTP-defined core infarct volumes (processed via Shukun software) were recorded. Prognostic outcome was defined by the 90-day modified Rankin Scale (mRS). Statistical analysis included logistic regression, ROC curve analysis, and Spearman correlation. Results: Patients with poor outcomes had significantly larger CTP-derived infarct core volumes and lower ASPECTS scores (both P< 0.001). In the overall cohort, CTP (AUC=0.74) and ASPECTS (adjusted AUC=0.71) demonstrated comparable predictive performance, with no statistically significant difference. In subgroup analyses stratified by onset-to-treatment time, both modalities remained predictive, and no significant differences in predictive accuracy were observed between ASPECTS and CTP in either the ≤ 6-hour or 6– 24-hour groups. A moderate negative correlation was observed between ASPECTS and core infarct volume (r=– 0.61, P< 0.001). Conclusion: Both ASPECTS and CTP-derived core infarct volume predict functional outcomes in AIS patients undergoing endovascular therapy, with comparable performance. ASPECTS offers a rapid assessment, whereas CTP provides quantitative evaluation. The two modalities may serve complementary roles in clinical decision-making. Keywords: ASPECTS, CT perfusion, acute ischemic stroke, endovascular therapy, prognosis
wang et al. (Wed,) studied this question.