The study introduces the Artery Occlusion Image Score (AOIS), a novel metric derived from computed tomographic angiography (CTA) to evaluate the severity of occlusions in main intracranial arteries for patients with acute ischemic stroke (AIS). The study involved 439 patients categorized into three groups based on the location of their infarcts: anterior circulation infarcts (ACI), posterior circulation infarcts (PCI), and both ACI and PCI.

The AOIS was compared to existing metrics like the Basilar Artery on Computed Tomography Angiography (BATMAN) score, the Clot Burden Score (CBS), and the National Institutes of Health Stroke Scale (NIHSS). The AOIS showed high sensitivity and specificity in both the ACI (86.3% and 85.0% respectively) and PCI groups (88.9% and 90.0% respectively), surpassing CBS and BATMAN in predicting patient prognosis. In the combined ACI + PCI group, AOIS correlated well with NIHSS scores (Spearman’s ρ = 0.602, P < .001).

This metric is significant as it is the first CTA-based scoring system that evaluates both anterior and posterior circulations, offering a comprehensive assessment tool for AIS. It is also comparable in scoring time to CBS and BATMAN, making it a practical option for clinical use.