title: Low Alberta stroke program early computed tomography score within 3 hours of onset predicts subsequent symptomatic intracranial hemorrhage in patients treated with 0.6 mg/kg Alteplase.
abstract: BACKGROUND
  The significance of early ischemic changes (EICs) on computed tomography (CT) in selecting candidates for thrombolysis remains controversial. The Alberta Stroke Program Early CT Score (ASPECTS) provides a semiquantitative scale that scores EICs within the middle cerebral artery territory using a 10-point grading system. We examined whether ASPECTS can predict the response to intravenous thrombolysis within 3 hours of stroke onset and incidence of secondary hemorrhage.
  
  
  METHODS
  Data from the Japan Alteplase Clinical Trial (J-ACT), in which 103 patients were included, were evaluated to assess the efficacy and safety of 0.6 mg/kg alteplase within 3 hours. All CT hardcopies were reevaluated retrospectively using the ASPECTS system. Multivariate logistic regression analysis was undertaken to determine whether an effect of ASPECTS existed on a defined favorable outcome as 0 or 1 on the modified Rankin Scale at 3 months, and symptomatic intracranial hemorrhage (sICH) within 36 hours.
  
  
  RESULTS
  The median ASPECTS value was 10 (range 3 to 10), and 56.3% revealed no evidence of EICs. ASPECTS had no effect on the patients' outcome, although a higher age and National Institutes of Health Stroke Scale score were negatively associated with a favorable outcome. On the other hand, lower ASPECTS was significantly associated with sICH (odds ratio [OR] 2.224; 95% confidence interval [CI] 1.227-4.032; P = .0084) and systolic blood pressure (OR 1.090; 95% CI 1.007-1.180; P = .0323) and the pre-ictal use of antiplatelet medications (OR 15.551; 95% CI 1.144-211.374; P = .0393).
  
  
  CONCLUSIONS
  In J-ACT, patients with low ASPECTS values have an increased risk of thrombolysis-related sICH.
authors: Department of Neurology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. terry07@kumamoto-u.ac.jp
authors: Teruyuki
authors: T
authors: Hirano
authors: Makoto
authors: M
authors: Sasaki
authors: Noriaki
authors: N
authors: Tomura
authors: Yasunobu
authors: Y
authors: Ito
authors: Shotai
authors: S
authors: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography / Q000379:methods*; D002986:Clinical Trials as Topic; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator