title: Analysis of DWI ASPECTS and recanalization outcomes of patients with acute-phase cerebral infarction.
abstract: In order to rapidly judge the response to intravenous tissue plasminogen activator (Ⅳ tPA) treatment, we retrospectively analyzed clinical data, such as MRI diffusion-weighted images (DWI), and treatment outcomes in 73 patients who developed anterior circulation disorders. The patients with favorable outcomes (modified Rankin Scale [mRS]: 2 or less) at discharge accounted for 32.9%. In these patients, the National Institutes of Health Stroke Scale (NIHSS) value, DWI Alberta Stroke Programme Early CT Score (ASPECTS), and the incidence of large artery (internal carotid artery [ICA]/sphenoidal segment of the middle cerebral artery [M1]) occlusion at their hospital visit were lower, higher, and lower, respectively (all P < 0.05 in univariate analysis). Multivariate analysis showed significant differences in DWI ASPECTS and the incidence of large artery occlusion. A DWI ASPECTS of at least 8 was found to be predictive of favorable outcomes. However, subclass analysis in the group with a DWI ASPECTS of 8 or higher predicting favorable outcome revealed 13 patients (41.9%) with unfavorable (mRS, 3-6) outcome. The factor associated with unfavorable outcomes is ICA occlusion. The combination of DWI ASPECTS and MRA appeared to be useful for predicting outcomes of Ⅳ tPA.
authors.affiliation: Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Shigeta
authors.forename: Kikuo
authors.initials: K
authors.lastname: Ohno
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takasato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Masaoka
authors.forename: Takanori
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsushige
authors.forename: Motoki
authors.initials: M
authors.lastname: Inaji
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sumiyoshi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Momose
authors.forename: Takuya
authors.initials: T
authors.lastname: Maeda
authors.forename: Jyuri
authors.initials: J
authors.lastname: Kiyokawa
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D002544:Cerebral Infarction / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017700:Embolism, Cholesterol / Q000175:diagnosis; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy; D007275:Injections, Intravenous; D020766:Intracranial Embolism / Q000175:diagnosis; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010351:Patient Discharge; D012189:Retrospective Studies; D059409:Stroke, Lacunar / Q000175:diagnosis; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator