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Importance of early ischemic computed tomography changes using ASPECTS in NINDS rtPA Stroke Study
Andrew M Demchuk1, Michael D Hill, Philip A Barber
1Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada. ademchuk@ucalgary.ca
Stroke
|September 17, 2005
Summary
Early ischemic changes on CT scans do not prevent thrombolysis for acute ischemic stroke. Favorable ASPECTS scores may indicate a trend toward greater benefit from tPA treatment.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Early ischemic changes (EIC) on computed tomography (CT) scans for acute ischemic stroke are controversial.
- The Alberta Stroke Program Early CT Score (ASPECTS) quantifies EIC within the middle cerebral artery territory.
Purpose of the Study:
- To determine if ASPECTS modifies treatment outcomes in acute ischemic stroke patients receiving thrombolysis.
- To systematically review CT scans from the NINDS rtPA Stroke Study to assess the role of ASPECTS.
Main Methods:
- ASPECTS scoring was performed by expert readers on 608 CT scans from the NINDS rtPA Stroke Study.
- Readers were blinded to clinical information, follow-up imaging, and outcomes.
- Multivariable logistic regression analyzed the interaction between ASPECTS and tPA treatment response, outcome, and hemorrhage risk.
Main Results:
- 57.2% of scans showed EIC (ASPECTS <10).
- Dichotomized ASPECTS (8-10 vs. <8) did not show a treatment-modifying effect on good outcome.
- A trend towards lower 90-day mortality with tPA was observed in patients with ASPECTS 8-10 (NNT=5) compared to ASPECTS 3-7 (NNT=8).
Conclusions:
- Baseline ASPECTS did not demonstrate treatment effect modification in the NINDS rtPA Stroke Study.
- Excluding patients from thrombolysis based on EIC (low ASPECTS) is not supported by these findings.
- Favorable baseline CT scans (ASPECTS >7) trend towards reduced mortality and increased benefit from tPA.