Since its development at the turn of the millennium, the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) [
1] has become the ubiquitous scoring system for evaluating early ischemic changes at baseline acute stroke imaging, mainly with non-contrast computed tomography (NCCT). ASPECTS is used as a triaging tool and has been incorporated into various best practice guidelines for the early management of patients with acute ischemic stroke [
2]. For instance, the European Stroke Organization guidelines strongly recommend mechanical thrombectomy in patients with an anterior circulation large vessel occlusion presenting within 6 h of stroke onset and NCCT ASPECTS ≥ 6 [
2]. Recent randomized controlled trials have also demonstrated the efficacy of mechanical thrombectomy in patients with large ischemic core (e.g., ASPECTS 3 to 5) [
3,
4]. …