Published online before print July 3, 2003, doi: 10.1161/01.STR.0000082483.37127.D0
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(Stroke. 2003;34:1925.)
© 2003 American Heart Association, Inc.
Original Contributions |
Selection of Acute Ischemic Stroke Patients for Intra-Arterial Thrombolysis With Pro-Urokinase by Using ASPECTS
From the Calgary Stroke Program (M.D.H., M.E., A.M.B.), Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada; the Department of Radiology (H.A.W.), University of Wisconsin, Madison; Yale University Medical School (F.A.), New Haven, Conn; the Cleveland Clinic Neurovascular Center (A.F.), Cleveland, Ohio; Department of Radiology, University of California at San Francisco Medical School (R.T.H., W.P.D., N.J.F.), San Francisco, Calif; the University of Pittsburgh Medical Center Stroke Institute (L.R.W.) and the Department of Neurology, University of Pittsburgh Medical School, Pittsburgh, Pa; the Department of Medical Imaging (H.R.), University of Toronto/UHN, Toronto, Ontario, Canada; and Abbott Laboratories (C.A.F., G.S.), Abbott Park, Ill.
Correspondence to Michael D. Hill, MD, FRCPC, Room 1242A, Foothills Hospital, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada. E-mail michael.hill{at}calgaryhealthregion.ca
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 >7 or 
7. 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 >7 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 7 group. After adjustment for baseline characteristics, the risk ratio in the ASPECTS score >7 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 >7 were 3 times more likely to have an independent functional outcome with thrombolytic treatment compared with control. Patients with a baseline ASPECTS 7 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.
Key Words: computed tomography • randomized controlled trials • stroke, acute • stroke, ischemic • thrombolysis • urokinase
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