Wei-Zhen Lu1, Hui-An Lin2, Chyi-Huey Bai3,4,5, Sheng-Feng Lin3,6,7. 1. Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. 2. Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan. 3. School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan. 4. Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 5. Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan. 6. Division of Hospitalist, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan. 7. Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan.
Abstract
BACKGROUND AND PURPOSE: Patients with posterior circulation acute ischemic stroke exhibit varied clinical presentations and functional outcomes. Whether posterior circulation acute stroke prognosis early computed tomography scores (PC-ASPECTS) predict unfavorable functional outcomes (UFO) for patients treated with different therapeutic regimens is unclear. METHODS: According to PRISMA guidelines, we performed a systematic search of electronic databases for studies assessing the functional outcomes of posterior circulation acute ischemic stroke using baseline PC-ASPECTS. The following three scales of PC-ASPECTS were retrieved: UFO prediction by using PC-ASPECTS per score decrease, UFO prediction by using binary PC-ASPECTS with a cut-off value, and the difference in PC-ASPECTS between patients with unfavorable and favorable functional outcomes. Moreover, a subgroup analysis was conducted for patients treated with intra-arterial endovascular treatment (IA-EVT) only. Sensitivity analysis with different definition of UFO and image modalities were also conducted. RESULTS: In total, 25 studies were included. In scale 1, PC-ASPECTS significantly predicted UFO (odds ratio [OR]: 1.66 per score decrease, 95% confidence interval [CI]: 1.32-2.07). In scale 2, binary PC-ASPECTS with a cut-off value between 6 and 9 significantly predicted UFO (OR: 3.91, 95% CI: 2.54-6.01). In scale 3, patients with UFO had lower PC-ASPECTS than those with favorable outcomes (standardized mean difference [SMD]: -0.67, 95% CI: -0.8 to -0.55). For patients treated with IA-EVT only, the scales demonstrated consistent results. Sensitivity analysis showed PC-ASPECTS significantly predicted UFO in both definitions of modified Rankin Scale ≥ 3 and ≥ 4, and magnetic resonance imaging was preferred imaging modality for PC-ASPECTS evaluation. CONCLUSION: Baseline PC-ASPECTS is effective in predicting UFO for patients with posterior circulation acute ischemic stroke treated with different therapeutic regimens.
BACKGROUND AND PURPOSE:Patients with posterior circulation acute ischemic stroke exhibit varied clinical presentations and functional outcomes. Whether posterior circulation acute stroke prognosis early computed tomography scores (PC-ASPECTS) predict unfavorable functional outcomes (UFO) for patients treated with different therapeutic regimens is unclear. METHODS: According to PRISMA guidelines, we performed a systematic search of electronic databases for studies assessing the functional outcomes of posterior circulation acute ischemic stroke using baseline PC-ASPECTS. The following three scales of PC-ASPECTS were retrieved: UFO prediction by using PC-ASPECTS per score decrease, UFO prediction by using binary PC-ASPECTS with a cut-off value, and the difference in PC-ASPECTS between patients with unfavorable and favorable functional outcomes. Moreover, a subgroup analysis was conducted for patients treated with intra-arterial endovascular treatment (IA-EVT) only. Sensitivity analysis with different definition of UFO and image modalities were also conducted. RESULTS: In total, 25 studies were included. In scale 1, PC-ASPECTS significantly predicted UFO (odds ratio [OR]: 1.66 per score decrease, 95% confidence interval [CI]: 1.32-2.07). In scale 2, binary PC-ASPECTS with a cut-off value between 6 and 9 significantly predicted UFO (OR: 3.91, 95% CI: 2.54-6.01). In scale 3, patients with UFO had lower PC-ASPECTS than those with favorable outcomes (standardized mean difference [SMD]: -0.67, 95% CI: -0.8 to -0.55). For patients treated with IA-EVT only, the scales demonstrated consistent results. Sensitivity analysis showed PC-ASPECTS significantly predicted UFO in both definitions of modified Rankin Scale ≥ 3 and ≥ 4, and magnetic resonance imaging was preferred imaging modality for PC-ASPECTS evaluation. CONCLUSION: Baseline PC-ASPECTS is effective in predicting UFO for patients with posterior circulation acute ischemic stroke treated with different therapeutic regimens.
Authors: Volker Puetz; Andrei Khomenko; Michael D Hill; Imanuel Dzialowski; Patrik Michel; Christian Weimar; Christine A C Wijman; Heinrich P Mattle; Stefan T Engelter; Keith W Muir; Thomas Pfefferkorn; David Tanne; Kristina Szabo; L Jaap Kappelle; Ale Algra; Ruediger von Kummer; Andrew M Demchuk; Wouter J Schonewille Journal: Stroke Date: 2011-09-29 Impact factor: 7.914
Authors: Louis R Caplan; Robert J Wityk; Thomas A Glass; Jorge Tapia; Ladislav Pazdera; Hui-Meng Chang; Phillip Teal; John F Dashe; Claudia J Chaves; Joan C Breen; Kostas Vemmos; Pierre Amarenco; Barbara Tettenborn; Megan Leary; Conrad Estol; L Dana Dewitt; Michael S Pessin Journal: Ann Neurol Date: 2004-09 Impact factor: 10.422