BACKGROUND AND PURPOSE: In patients with middle cerebral artery trunk occlusion we investigated whether the diffusion-weighted imaging- the Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) predicts short-term neurological recovery after intravenous recombinant tissue plasminogen activator administration, and investigated how DWI-ASPECTS relates to clinical outcome. METHODS: Dramatic recovery was defined as a ≥ 10-point reduction or a total National Institutes of Health Stroke Scale score of 0 to 1 at 24 hours and 7 days. Early recanalization was defined as recanalization within 1 hours after intravenous recombinant tissue plasminogen activator. Favorable outcome at 3 months was defined as a modified Rankin Scale score of 0 to 2. RESULTS: Sixty-six patients (median age [interquartile], 79 [70-85] years, male; 34 [52%]) were enrolled. DWI-ASPECTS was 6 (5-9). Dramatic recovery was seen in 16 (24%) and 26 (39%) patients at 24 hours and on day 7, respectively. Early recanalization occurred in 22 (33%) patients. DWI-ASPECTS ≥ 7 was an independent predictor of dramatic recovery at 24 hours (odds ratio, 100.85; 95% confidence interval, 4.29-2371.40; P=0.004) and 7 days (odds ratio, 14.15; 95% confidence interval, 2.21-90.48; P=0.005). Although the favorable outcome rate was not significantly different between patients with DWI-ASPECTS ≥ 7 with and without early recanalization (60% versus 31%; P=0.228), it was statistically more frequent in patients with DWI-ASPECTS <7 with early recanalization than those without early recanalization (38% versus 0%; P=0.017). CONCLUSIONS: DWI-ASPECTS predicted short-term recovery in patients with middle cerebral artery trunk occlusion receiving intravenous recombinant tissue plasminogen activator. In patients with lower DWI-ASPECTS, there may still be benefit from early recanalization.
BACKGROUND AND PURPOSE: In patients with middle cerebral artery trunk occlusion we investigated whether the diffusion-weighted imaging- the Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) predicts short-term neurological recovery after intravenous recombinant tissue plasminogen activator administration, and investigated how DWI-ASPECTS relates to clinical outcome. METHODS: Dramatic recovery was defined as a ≥ 10-point reduction or a total National Institutes of Health Stroke Scale score of 0 to 1 at 24 hours and 7 days. Early recanalization was defined as recanalization within 1 hours after intravenous recombinant tissue plasminogen activator. Favorable outcome at 3 months was defined as a modified Rankin Scale score of 0 to 2. RESULTS: Sixty-six patients (median age [interquartile], 79 [70-85] years, male; 34 [52%]) were enrolled. DWI-ASPECTS was 6 (5-9). Dramatic recovery was seen in 16 (24%) and 26 (39%) patients at 24 hours and on day 7, respectively. Early recanalization occurred in 22 (33%) patients. DWI-ASPECTS ≥ 7 was an independent predictor of dramatic recovery at 24 hours (odds ratio, 100.85; 95% confidence interval, 4.29-2371.40; P=0.004) and 7 days (odds ratio, 14.15; 95% confidence interval, 2.21-90.48; P=0.005). Although the favorable outcome rate was not significantly different between patients with DWI-ASPECTS ≥ 7 with and without early recanalization (60% versus 31%; P=0.228), it was statistically more frequent in patients with DWI-ASPECTS <7 with early recanalization than those without early recanalization (38% versus 0%; P=0.017). CONCLUSIONS: DWI-ASPECTS predicted short-term recovery in patients with middle cerebral artery trunk occlusion receiving intravenous recombinant tissue plasminogen activator. In patients with lower DWI-ASPECTS, there may still be benefit from early recanalization.
Authors: Dezhi Liu; Fabien Scalzo; Sidney Starkman; Neal M Rao; Jason D Hinman; Doojin Kim; Latisha K Ali; Jeffrey L Saver; Ali Reza Noorian; Kwan Ng; Conrad Liang; Sunil A Sheth; Bryan Yoo; Xinfeng Liu; David S Liebeskind Journal: Cerebrovasc Dis Date: 2015-10-29 Impact factor: 2.762
Authors: H Kuang; M Najm; D Chakraborty; N Maraj; S I Sohn; M Goyal; M D Hill; A M Demchuk; B K Menon; W Qiu Journal: AJNR Am J Neuroradiol Date: 2018-11-29 Impact factor: 3.825