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(Stroke. 2004;35:156.)
© 2004 American Heart Association, Inc.

Original Contributions

Editorial Comment—The MOST Score: Modifying the Open-Artery "Good"–Closed-Artery "Bad" Approach to Thrombolysis Prognosis

Department of Neurology, Ochsner Foundation Clinic and Hospital, New Orleans, Louisiana

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The rapidity and degree of recanalization has been shown to predict good outcome in thrombolysis of acute ischemic stroke.^1,2 However, despite complete recanalization, many patients continue to do poorly. Some never recover function, while others experience deterioration after improvement³ or symptomatic intracerebral hemorrhage. Conversely, many patients experience complete recovery despite continued vessel obstruction. Several clinical factors have been shown to predict poor outcome including continued arterial occlusion, slow recanalization, hyperglycemia, systolic hypertension, and early ischemic changes on the baseline CT scan.^4,5

In this report, Molina et al prospectively collected patients who presented with acute stroke syndromes with transcranial Doppler (TCD)-demonstrated middle cerebral artery occlusions and were treated using standard intravenous tissue plasminogen activator (tPA) protocols.⁶ Hemodynamic, radiologic, laboratory, and clinical data were examined, and 5 variables were found to be associated with good outcome (defined as a modified Rankin Scale score 2). These 5 variables (degree of recanalization, site of occlusion, early ischemic CT scan changes, severity of clinical presentation, and presence of moderate hypertension) were then assigned values as part of the scoring tool to predict outcome (the MOST [Multimodal Outcome Score for Stroke Thrombolysis] score).

In line with previous reports, the authors found that presence of recanalization had the strongest predictive value (OR, 4.11; P<0.001). Interestingly, 25% of patients without recanalization experienced a good outcome. Early ischemic changes on CT as measured by the Alberta Stroke Programme Early CT Score (ASPECTS) were found to be highly predictive as well (OR, 2.98; P=0.0253). These findings suggest that . . . [Full Text of this Article]

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