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Association of Pretreatment ASPECTS Scores with tPA‐Induced Arterial Recanalization in Acute Middle Cerebral Artery Occlusion
Author(s) -
Tsivgoulis Georgios,
Saqqur Maher,
Sharma Vijay K.,
Lao Annabelle Y.,
Hoover Steven L.,
Alexandrov Andrei V.
Publication year - 2008
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2007.00169.x
Subject(s) - medicine , interquartile range , middle cerebral artery , thrombolysis , modified rankin scale , transcranial doppler , occlusion , bolus (digestion) , cardiology , anesthesia , ischemia , ischemic stroke , myocardial infarction
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.