Περίληψη:
BACKGROUND AND PURPOSE
The Alberta Stroke Program Early CT-Score (ASPECTS) assesses early
ischemic changes within the middle cerebral artery (MCA) and predicts
poor outcome and increased risk for thrombolysis-related symptomatic
ICH. We evaluated the potential relationship between pretreatment
ASPECTS and tPA-induced recanalization in patients with MCA occlusions.
SUBJECTS & METHODS
Consecutive patients with acute ischemic stroke due to MCA occlusion
were treated with standard IV-tPA and assessed with transcranial Doppler
(TCD) for arterial recanalization. Early recanalization was determined
with previously validated Thrombolysis in Brain Ischemia (TIBI)
flow-grading system at 120 minutes after tPA-bolus. All pretreatment
CT-scans were prospectively scored by trained investigators blinded to
TCD findings. Functional outcome at 3 months was evaluated using the
modified Rankin Scale (mRS).
RESULTS
IV-tPA was administered in 192 patients (mean age 68 +/- 14 years,
median NIHSS-score 17). Patients with complete recanalization (n= 51)
had higher median pretreatment ASPECTS (10, interquartile range 2) than
patients with incomplete or absent recanalization (n = 141; median
ASPECTS 9, interquartile range 3, P = .034 Mann-Whitney U-test). An
ASPECTS <= 6 was documented in 4% and 17% of patients with present and
absent recanalization, respectively (P = .019). Pretreatment ASPECTS was
associated with complete recanalization (OR per 1-point increase: 1.54;
95% CI 1.06-2.22, P = .023) after adjustment for baseline
characteristics, risk factors, NIHSS-score, pretreatment TIBI grades and
site of arterial occlusion on baseline TCD. Complete recanalization (OR:
33.97, 95% CI 5.95-185.99, P < .001) and higher ASPECTS (OR per 1-point
increase: 1.91; 95% CI 1.17-3.14, P = .010) were independent predictors
of good functional outcome (mRS 0-2).
CONCLUSIONS
Higher pretreatment ASPECT-scores are associated with a greater chance
of complete recanalization and favorable long-term outcome in
tPA-treated patients with acute MCA occlusion.
Συγγραφείς:
Tsivgoulis, Georgios
Saqqur, Maher
Sharma, Vijay K.
Lao,
Annabelle Y.
Hoover, Steven L.
Alexandrov, Andrei V. and
CLOTBUST Investigators
