Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS.
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 < 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 < or =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 < or =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.
Hill
Michael D
MD
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada. michael.hill@calgaryhealthregion.ca
Rowley
Howard A
HA
Adler
Felix
F
Eliasziw
Michael
M
Furlan
Anthony
A
Higashida
Randall T
RT
Wechsler
Lawrence R
LR
Roberts
Heidi C
HC
Dillon
William P
WP
Fischbein
Nancy J
NJ
Firszt
Carolyn M
CM
Schulz
Gregory A
GA
Buchan
Alastair M
AM
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002170:Canada; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D011994:Recombinant Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D014568:Urokinase-Type Plasminogen Activator; C067551:saruplase