Extent of early ischemic changes on computed tomography (CT) before thrombolysis - Prognostic value of the Alberta Stroke Program Early CT Score in ECASS II

被引:183
作者
Dzialowski, I
Hill, MD
Coutts, SB
Demchuk, AM
Kent, DM
Wunderlich, O
von Kummer, R
机构
[1] Foothills Prov Gen Hosp, Dept Clin Neurosci, Calgary Stroke Program, Calgary, AB T2N 2T9, Canada
[2] Univ Technol Dresden, Dept Neuroradiol, Dresden, Germany
[3] Univ Calgary, Dept Community Hlth Sci, Calgary, AB T2N 1N4, Canada
[4] Univ Calgary, Dept Med, Calgary, AB T2N 1N4, Canada
[5] Tufts Univ, Sch Med, Tufts New England Med Ctr, Inst Clin Res & Hlth Policy Studies,Dept Med, Boston, MA 02111 USA
关键词
brain ischemia; computed tomography; intracranial hemorrhage; stroke; thrombolysis;
D O I
10.1161/01.STR.0000206215.62441.56
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose - The significance of early ischemic changes (EICs) on computed tomography (CT) to triage patients for thrombolysis has been controversial. The Alberta Stroke Program Early CT Score ( ASPECTS) semiquantitatively assesses EICs within the middle cerebral artery territory using a10-point grading system. We hypothesized that dichotomized ASPECTS predicts response to intravenous thrombolysis and incidence of secondary hemorrhage within 6 hours of stroke onset. Methods - Data from the European-Australian Acute Stroke Study (ECASS) II study were used in which 800 patients were randomized to recombinant tissue plasminogen activator (rt-PA) or placebo within 6 hours of symptom onset. We retrospectively assessed all baseline CT scans, dichotomized ASPECTS at <= 7 and > 7, defined favorable outcome as modified Rankin Scale score 0 to 2 after 90 days, and secondary hemorrhage as parenchymal hematoma 1 (PH1) or PH2. We performed a multivariable logistic regression analysis and assessed for an interaction between rt-PA treatment and baseline ASPECTS score. Results - We scored ASPECTS > 7 in 557 and <= 7 in 231 patients. There was no treatment-by-ASPECTS interaction with dichotomized ASPECTS ( P = 0.3). This also applied for the 0- to 3-hour and 3-to 6-hour cohorts. However, a treatment-by-ASPECTS effect modification was seen in predicting PH (0.043 for the interaction term), indicating a much higher likelihood of thrombolytic-related parenchymal hemorrhage in those with ASPECTS <= 7. Conclusion - In ECASS II, the effect of rt-PA on functional outcome is not influenced by baseline ASPECTS. Patients with low ASPECTS have a substantially increased risk of thrombolytic-related PH.
引用
收藏
页码:973 / 978
页数:6
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