[ASPECTS-DWI, arterial occlusion sites and subtype of acute ischemic stroke have a relation with outcome following intravenous rt-PA therapy].
OBJECTIVE
We evaluated the usefulness of rating diffusion weighted images (DWI) using semiquantitative scores modified from the Alberta Stroke Programme Early CT Score (ASPECTS) to predict deterioration of neurological symptoms in patients with hyperacute ischemic stroke who had undergone thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).


METHODS
We examined 84 patients with acute ischemic stroke treated with intravenous rt-PA. Ischemic changes and vascular lesions were identified using DWI, and magnetic resonance angiography. Early ischemic signs were assessed using ASPECTS-DWI (11 points). Independent outcome was defined by NIHSS at 24 hours after intravenous rt-PA therapy.


RESULTS
A total of 58 patients were studied, and NIHSS 27 (46.6%) of them had improved by 4 points in 24 hours.


CONCLUSIONS
Cases of 0≦AD≦3, cardioembolic type cases with internal carotid artery occlusion in the group of 4≦AD≦7 and branch atheromatous disease in the group of 8≦AD were poor outcome at NIHSS 24 hours after intravenous rt-PA therapy for acute ischemic stroke patients.
Department of Neurosurgery, Hiroshima City Hospital, Japan.
Masaru
M
Idei
Tatsuya
T
Sasaki
Tomoyuki
T
Tanabe
Kenichirou
K
Muraoka
Kinya
K
Terada
Toshinari
T
Meguro
Nobuyuki
N
Hirotsune
Shigeki
S
Nishino
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator