Extremely Early Computed Tomography Signs in Hyperacute Ischemic Stroke as a Predictor of Parenchymal Hematoma

Okazaki, Shuhei; Moriwaki, Hiroshi; Minematsu, Kazuo

doi:10.1159/000113862

Cited by 9 publications

(6 citation statements)

References 46 publications

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“…Baseline DWI was conducted for ischemic change and quantified using the DWI-ASPECTS. Because patients with extensive early ischemic changes are at increased risk of symptomatic intracerebral hemorrhage [16,23], the presence of extensive early ischemic changes, which was evaluated by the physician in charge, excluded patients from thrombolysis. Stroke neurologists determined the National Institutes of Health Stroke Scale (NIHSS) [24] scores before and 24 h after tPA infusion, as well as the modified Rankin Scale (mRS) [25] scores at 90 days.…”

Section: Methodsmentioning

confidence: 99%

Presence of Deep White Matter Lesions on Diffusion-Weighted Imaging Is a Negative Predictor of Early Dramatic Improvement after Intravenous Tissue Plasminogen Activator Thrombolysis

et al. 2010

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Background: The impact of deep white matter lesions observed at the corona radiata on diffusion-weighted MRI (DWI-W lesions) on the clinical recovery of patients after tissue plasminogen activator (tPA) therapy is unclear. Our goal was to elucidate whether DWI findings before tPA could predict clinical recovery. Methods: A total of 83 consecutive patients with hyperacute anterior circulation ischemic stroke were enrolled. All patients underwent MRI within 3 h and received intravenous tPA. The relationships among the Alberta Stroke Program Early CT Score (ASPECTS) on DWI (DWI-ASPECTS), DWI-W lesions, early dramatic improvement (≧10-point reduction in the total National Institutes of Health Stroke Scale, NIHSS, score or a total NIHSS score of 0–2 after 24 h), early improvement (≧4-point reduction in the total NIHSS score after 24 h) and worsening (≧4-point increase in the total NIHSS score after 24 h) were assessed. Results: The median of the baseline DWI-ASPECTS value was 9 (range: 5–10), and DWI-W lesions were found in 36 patients (43%). Patients with early dramatic improvement had a shorter time from onset to tPA (116.1 ± 34.9 vs. 133.2 ± 33.1 min; p = 0.0281) and higher DWI-ASPECTS (medians: 9 vs. 9; p = 0.0568). DWI-W lesions were seen less frequently in patients with than without early dramatic improvement (26 vs. 54%; p = 0.0213). Multivariate logistic regression analysis demonstrated that absence of DWI-W lesions (OR: 1.80; 95% CI: 1.08–3.13; p = 0.0279), higher ASPECTS (OR: 1.56; 95% CI: 1.06–2.46; p = 0.0346) and shorter time from onset to tPA (OR: 0.98; 95% CI: 0.97–0.99; p = 0.0429) were independent predictors of early dramatic improvement. Conclusions: DWI-ASPECTS and DWI-W lesions appear to be useful tools for predicting early dramatic improvement.

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Section: Methodsmentioning

confidence: 99%

Presence of Deep White Matter Lesions on Diffusion-Weighted Imaging Is a Negative Predictor of Early Dramatic Improvement after Intravenous Tissue Plasminogen Activator Thrombolysis

et al. 2010

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“…The ASPECTS value has been shown to be associated with vascular pathology [21,22] and is a simple and accurate predictor of functional outcome after thrombolytic treatment [20,23,24]. Patients with an ASPECTS value higher than 7 will probably respond to treatment, whereas those with a value lower than 5 are much less likely to benefit [25].…”

Section: Introductionmentioning

confidence: 99%

First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

et al. 2016

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Background: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). Methods: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. Results: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. Conclusions: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital.

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“…The original ASPECTS study showed that ASPECTS of 7 or below differentiated patients who were highly unlikely to achieve independent functional outcome [22,23,24,25,26,27,28], although this study focused on stroke patients who received thrombolytic therapy. A later study similarly showed that ASPECTS ≤7 for an early CT predicts a high risk for parenchymal hematoma following acute ischemic stroke, in patients without thrombolysis [29]. ASPECTS may be used as a diagnostic tool for subsequent malignant MCA infarction.…”

Section: Introductionmentioning

confidence: 99%

Low Alberta Stroke Program Early CT Score (ASPECTS) Associated with Malignant Middle Cerebral Artery Infarction

et al. 2014

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Background: Early decompressive hemicraniectomy following malignant middle cerebral artery (MCA) infarction reduces mortality and improves clinical outcome. Imaging predictors of malignant infarction may serve as ‘red flags', prompting intensive neurological monitoring and timely intervention. Our objective is to investigate whether lower ASPECTS (Alberta Stroke Program Early CT Score) is associated with malignant MCA infarction. Methods: Aretrospective cohort study of all patients with MCA territory ischemic strokes who were admitted to the Royal Melbourne Hospital (RMH) between 1 January 2009 and 31 December 2009 (226 patients included). The main outcome measures were ASPECTS on admission for each patient and the development of malignant MCA infarction. Results: One-hundred-and-eight patients out of 226 (48%) developed malignant MCA infarction. Good (>0.8) inter-rater agreement between observers scoring ASPECTS was observed using weighted kappa, intra-class correlation coefficient and Lin's concordance coefficients. Using receiver operating characteristic (ROC) curve analysis, we validated that ASPECTS 7 was the optimal cut-off score to determine progression to malignant infarction, providing 50% sensitivity and 86% specificity. One hundred and fifty six patients had ASPECTS >7 (69%) and 70 patients had ASPECTS ≤7 (31%). Patients with ASPECTS ≤7 were significantly younger than those with ASPECTS >7, with the median age of each group being 72.5 and 78 respectively (p = 0.02); otherwise the groups were well-matched. With ASPECTS ≤7, 54 out of 70 patients (77%) developed malignant MCA infarction, compared with 54 out of 156 patients (35%) with ASPECTS >7 (age-adjusted OR = 0.12, 95% CI: 0.06, 0.25; p < 0.0001). If ASPECTS ≤7 is a positive result, then the positive predictive value is 77% and the negative predictive value is 65%. The median ASPECTS for developing malignant MCA infarction was 7.5 (IQR: 5 to 10), while the median ASPECTS for not developing MCA infarction was 10 (IQR: 8 to 10), resulting in a significant age-adjusted median difference of 2 (95% CI: 0.8, 3.2; p < 0.0001). We also found that coma on admission is associated with the development of malignant MCA infarction (OR = 22.63, 95% CI: 1.3, 393.7; p = 0.0323) and that a history of hypertension is not associated with the development of malignant MCA infarction (OR = 0.9707, 95% CI: 0.54, 1.75; p = 0.9213). Conclusions: ASPECTS ≤7 on initial brain CT in a patient with MCA infarction is associated with the development of malignant MCA infarction. We recommend close monitoring of, and early consideration of decompressive hemicraniectomy for, acute stroke patients with ASPECTS ≤7.

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Extremely Early Computed Tomography Signs in Hyperacute Ischemic Stroke as a Predictor of Parenchymal Hematoma

Cited by 9 publications

References 46 publications

Presence of Deep White Matter Lesions on Diffusion-Weighted Imaging Is a Negative Predictor of Early Dramatic Improvement after Intravenous Tissue Plasminogen Activator Thrombolysis

Presence of Deep White Matter Lesions on Diffusion-Weighted Imaging Is a Negative Predictor of Early Dramatic Improvement after Intravenous Tissue Plasminogen Activator Thrombolysis

First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

Low Alberta Stroke Program Early CT Score (ASPECTS) Associated with Malignant Middle Cerebral Artery Infarction

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