Published online before print February 23, 2006, doi: 10.1161/01.STR.0000206215.62441.56
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(Stroke. 2006;37:973.)
© 2006 American Heart Association, Inc.
Original Contributions |
Extent of Early Ischemic Changes on Computed Tomography (CT) Before Thrombolysis
Prognostic Value of the Alberta Stroke Program Early CT Score in ECASS II
From the Department of Clinical Neurosciences (I.D., M.D.H., S.B.C., A.M.D.), Calgary Stroke Program, University of Calgary, Alberta, Canada; Department of Neuroradiology (I.D., O.W., R.v.K.), University of Technology Dresden, Dresden, Germany; Departments of Community Health Sciences and Medicine (M.D.H.), University of Calgary, Alberta, Canada; and Institute for Clinical Research and Health Policy Studies (D.M.K.), Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass.
Correspondence to Imanuel Dzialowski, MD, Postdoctoral Fellow, Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Hospital, 1403 29th street NW, Calgary, Alberta, Canada. E-mail imanuel.dzialowski{at}calgaryhealthregion.ca
Background and Purpose— The significance of early ischemic changes (EICs) on computed tomography (CT) to triage patients for thrombolysis has been controversial. The Alberta Stroke Program Early CT Score (ASPECTS) semiquantitatively assesses EICs within the middle cerebral artery territory using a10-point grading system. We hypothesized that dichotomized ASPECTS predicts response to intravenous thrombolysis and incidence of secondary hemorrhage within 6 hours of stroke onset.
Methods— Data from the European-Australian Acute Stroke Study (ECASS) II study were used in which 800 patients were randomized to recombinant tissue plasminogen activator (rt-PA) or placebo within 6 hours of symptom onset. We retrospectively assessed all baseline CT scans, dichotomized ASPECTS at 
7 and >7, defined favorable outcome as modified Rankin Scale score 0 to 2 after 90 days, and secondary hemorrhage as parenchymal hematoma 1 (PH1) or PH2. We performed a multivariable logistic regression analysis and assessed for an interaction between rt-PA treatment and baseline ASPECTS score.
Results— We scored ASPECTS >7 in 557 and 7 in 231 patients. There was no treatment-by-ASPECTS interaction with dichotomized ASPECTS (P=0.3). This also applied for the 0- to 3-hour and 3- to 6-hour cohorts. However, a treatment-by-ASPECTS effect modification was seen in predicting PH (0.043 for the interaction term), indicating a much higher likelihood of thrombolytic-related parenchymal hemorrhage in those with ASPECTS 7.
Conclusion— In ECASS II, the effect of rt-PA on functional outcome is not influenced by baseline ASPECTS. Patients with low ASPECTS have a substantially increased risk of thrombolytic-related PH.
Key Words: brain ischemia • computed tomography • intracranial hemorrhage • stroke • thrombolysis
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