Association of pretreatment ASPECTS scores with tPA-induced arterial recanalization in acute middle cerebral artery occlusion

Georgios Tsivgoulis, Maher Saqqur, Vijay K. Sharma, Annabelle Y. Lao, Steven L. Hoover, Andrei Alexandrov

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)56-61
Number of pages6
JournalJournal of Neuroimaging
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Alberta
Middle Cerebral Artery Infarction
Stroke
Brain Ischemia
Middle Cerebral Artery
Nonparametric Statistics
Research Personnel

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Association of pretreatment ASPECTS scores with tPA-induced arterial recanalization in acute middle cerebral artery occlusion. / Tsivgoulis, Georgios; Saqqur, Maher; Sharma, Vijay K.; Lao, Annabelle Y.; Hoover, Steven L.; Alexandrov, Andrei.

In: Journal of Neuroimaging, Vol. 18, No. 1, 01.01.2008, p. 56-61.

Research output: Contribution to journalArticle

@article{86026591a13e45ff83b64e119a2a29c8,
title = "Association of pretreatment ASPECTS scores with tPA-induced arterial recanalization in acute middle cerebral artery occlusion",
abstract = "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.",
author = "Georgios Tsivgoulis and Maher Saqqur and Sharma, {Vijay K.} and Lao, {Annabelle Y.} and Hoover, {Steven L.} and Andrei Alexandrov",
year = "2008",
month = "1",
day = "1",
doi = "10.1111/j.1552-6569.2007.00169.x",
language = "English (US)",
volume = "18",
pages = "56--61",
journal = "Journal of Neuroimaging",
issn = "1051-2284",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Association of pretreatment ASPECTS scores with tPA-induced arterial recanalization in acute middle cerebral artery occlusion

AU - Tsivgoulis, Georgios

AU - Saqqur, Maher

AU - Sharma, Vijay K.

AU - Lao, Annabelle Y.

AU - Hoover, Steven L.

AU - Alexandrov, Andrei

PY - 2008/1/1

Y1 - 2008/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=38049051906&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38049051906&partnerID=8YFLogxK

U2 - 10.1111/j.1552-6569.2007.00169.x

DO - 10.1111/j.1552-6569.2007.00169.x

M3 - Article

VL - 18

SP - 56

EP - 61

JO - Journal of Neuroimaging

JF - Journal of Neuroimaging

SN - 1051-2284

IS - 1

ER -