Symptomatic ICH after IA thrombolysis with r-proUK for acute ischemic stroke occurs early after treatment and has high mortality. The risk of symptomatic ICH may be increased in patients with a blood glucose >200 mg/dL at stroke onset.

Background-Previous studies have suggested that baseline computed tomographic (CT) scans might be a useful tool for selecting particular ischemic stroke patients who would benefit from thrombolysis. The aim of the present study was to assess whether the baseline CT scan, assessed with the Alberta Stroke Program Early CT Score (ASPECTS), could identify ischemic stroke patients who might particularly benefit from intra-arterial thrombolysis of middle cerebral artery occlusion. Methods-Baseline and 24-hour follow-up CT scans of patients randomized within 6 hours of symptoms to intra-arterial thrombolysis with recombinant pro-urokinase or control in the PROACT-II study were retrospectively scored by using ASPECTS. Patients were stratified into those with ASPECTS Ͼ7 or Յ7. Independent functional outcome at 90 days was compared between the 2 strata according to treatment assignment. Results-The analysis included 154 patients with angiographically confirmed middle cerebral artery occlusion. The unadjusted risk ratio of an independent functional outcome, in favor of treatment, in the ASPECTS Ͼ7 group was 5.0 (95% confidence interval [CI], 1.3 to 19.2) compared with 1.0 (95% CI, 0.6 to 1.9) in the ASPECTS Յ7 group. After adjustment for baseline characteristics, the risk ratio in the ASPECTS score Ͼ7 was 3.2 (95% CI, 1.2 to 9.1). Similar favorable treatment effects were observed when secondary outcomes were used, but these did not reach statistical significance. Conclusions-Ischemic stroke patients with a baseline ASPECTS Ͼ7 were 3 times more likely to have an independent functional outcome with thrombolytic treatment compared with control. Patients with a baseline ASPECTS Յ7 were less likely to benefit from treatment. This observation suggests that ASPECTS can be both a useful clinical tool and an important method of baseline risk stratification in future clinical trials of acute stroke therapy.

on behalf of the PROACT-2 InvestigatorsBackground and Purpose-Sex influences outcome after intravenous thrombolysis. In a combined analysis of the tissue plasminogen activator clinical trials, a sex-by-treatment interaction was observed. We sought to confirm that observation in an independent data set. Methods-Data were from the Pro-Urokinase for Acute Cerebral Thromboembolism-2 (PROACT-2) trial. Baseline factors were compared by sex. The primary outcome was an assessment of a sex-by-treatment interaction term within a logistic regression model, using a modified Rankin Scale score Յ2 at 90 days as the binary outcome. We also assessed whether there were differences in CT-scan appearance and recanalization at 2 hours post-treatment. Results-In the PROACT-2 study of intra-arterial stroke thrombolysis, in both women and men, prourokinase resulted in better outcomes than control. A sex by prourokinase treatment interaction was observed, with women showing a larger treatment effect (20% absolute benefit) compared with men (10% absolute benefit). The reason for this interaction is that thrombolytic treatment nullifies the worse outcome for untreated women compared with men. The reasons for effect modification do not include improved recanalization at 2 hours among women. Conclusions-Women with middle cerebral artery ischemic stroke benefit more from intra-arterial therapy. Further study of how sex affects stroke outcome is needed. Key Words: gender Ⅲ stroke Ⅲ thrombolysis S everal studies have reported that treatment and outcomes differ between women and men for general stroke care. 1-4 Reasons for this result may include social factors, age or perhaps true differences in biology. [5][6][7] Analysis of pooled results of the intravenous tissue plasminogen activator (tPA) trials in acute ischemic stroke revealed surprising evidence that women may benefit more than men from intravenous thrombolysis. 8 This analysis was consistent with previously cited studies in that nonthrombolysed women fared worse than nonthrombolysed men. Among tPA-treated patients, the sex-effect was absent, and this resulted in female sex being a significant modifier of treatment-effect. However, this analysis was a post-hoc assessment and the association could have been the result of chance. We sought to confirm this result in an independent data set. MethodsThe Pro-Urokinase for Acute Cerebral Thromboembolism-2 (PROACT-2) study has been previously reported. 9 In brief, the study was a randomized, controlled, open-label clinical trial with blinded outcome evaluation, enrolling 180 patients with angiographically proven middle cerebral artery occlusion, randomized in a 2:1 ratio to intra-arterial prourokinase or heparin control. The study demonstrated a 15% absolute benefit in functional independence at 90-days (modified Rankin Score 0 to 2) accruing to patients receiving treatment with prourokinase. In this analysis we used data from the study to evaluate the hypothesis that sex influences outcome after treatment with prourokinase with a greater tre...

Background and Purpose-The purpose of this study was to evaluate the role of noncontrast CT in the selection of patients to receive thrombolytic therapy for acute ischemic stroke and to predict radiological and clinical outcomes. Methods-One hundred eighty patients with stroke due to middle cerebral artery (MCA) occlusion were randomized 2:1 within 6 hours of onset to receive intra-arterial recombinant prourokinase plus intravenous heparin or intravenous heparin only. Four hundred fifty-four CT examinations were digitized to calculate early infarct changes, infarct volumes, and hemorrhagic changes among the 162 patients treated as randomized (108 recombinant prourokinase-treated patients and 54 control patients). CT changes were correlated with baseline stroke severity, angiographic clot location, collateral vessels, and outcome at 90 days. Results-Baseline CT scans, 120 (75%) of 159, showed early infarct-related abnormalities. The baseline CT abnormality volume was not correlated with the baseline National Institutes of Health Stroke Scale (NIHSS) score (rϭϪ0.11) but was correlated weakly with the outcome (rϭ0.17, PϽ0.05). Compared with patients with M2 occlusions, patients with M1 MCA occlusions had significantly higher baseline NIHSS scores (PϽ0.05), more basal ganglia involvement on CT, and larger hypodensity volumes on follow-up CTs. Compared with patients with partial or no collateral supply, patients with full collateral supply had lower baseline NIHSS scores, significantly smaller baseline CT infarct volumes, and less cortical involvement (PϽ0.05). Conclusions-Noncontrast CT is not correlated with baseline stroke severity and does not predict outcome in patients with stroke due to MCA occlusion. However, baseline CT changes, clinical presentation, and the evolution of CT changes are influenced by clot location and the presence of a collateral supply.