title: DWI-ASPECTS as a predictor of dramatic recovery after intravenous recombinant tissue plasminogen activator administration in patients with middle cerebral artery occlusion.
abstract: OBJECTIVE
  In patients with middle cerebral artery trunk occlusion we investigated whether the diffusion-weighted imaging- the Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) predicts short-term neurological recovery after intravenous recombinant tissue plasminogen activator administration, and investigated how DWI-ASPECTS relates to clinical outcome.
  
  
  METHODS
  Dramatic recovery was defined as a ≥ 10-point reduction or a total National Institutes of Health Stroke Scale score of 0 to 1 at 24 hours and 7 days. Early recanalization was defined as recanalization within 1 hours after intravenous recombinant tissue plasminogen activator. Favorable outcome at 3 months was defined as a modified Rankin Scale score of 0 to 2.
  
  
  RESULTS
  Sixty-six patients (median age [interquartile], 79 [70-85] years, male; 34 [52%]) were enrolled. DWI-ASPECTS was 6 (5-9). Dramatic recovery was seen in 16 (24%) and 26 (39%) patients at 24 hours and on day 7, respectively. Early recanalization occurred in 22 (33%) patients. DWI-ASPECTS ≥ 7 was an independent predictor of dramatic recovery at 24 hours (odds ratio, 100.85; 95% confidence interval, 4.29-2371.40; P=0.004) and 7 days (odds ratio, 14.15; 95% confidence interval, 2.21-90.48; P=0.005). Although the favorable outcome rate was not significantly different between patients with DWI-ASPECTS ≥ 7 with and without early recanalization (60% versus 31%; P=0.228), it was statistically more frequent in patients with DWI-ASPECTS <7 with early recanalization than those without early recanalization (38% versus 0%; P=0.017).
  
  
  CONCLUSIONS
  DWI-ASPECTS predicted short-term recovery in patients with middle cerebral artery trunk occlusion receiving intravenous recombinant tissue plasminogen activator. In patients with lower DWI-ASPECTS, there may still be benefit from early recanalization.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan. aojyun@med.kawasaki-m.ac.jp
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects* / Q000502:physiology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator