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Early Ischemic Change on CT Versus Diffusion-Weighted Imaging for Patients With Stroke Receiving Intravenous Recombinant Tissue-Type Plasminogen Activator Therapy: Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI) rt-PA Registry.
MedLine Citation:
PMID:  21719764     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Alberta Stroke Programme Early CT Score (ASPECTS) is a quantitative topographical score to evaluate early ischemic change in the middle cerebral arterial territory on CT as well as on diffusion-weighted imaging (DWI). The aim of the present study was to elucidate the relationship between CT-ASPECTS and DWI-ASPECTS for patients with hyperacute stroke and their associations with outcomes after recombinant tissue-type plasminogen activator therapy based on a multicenter registry. METHODS: ASPECTS was assessed on both CT and DWI before intravenous 0.6 mg/kg alteplase in 360 patients with stroke (119 women, 71±11 years old). The outcomes were symptomatic intracerebral hemorrhage within 36 hours and independence at 3 months defined by a modified Rankin Scale score of 0 to 2. RESULTS: DWI-ASPECTS was positively correlated with CT-ASPECTS (ρ=0.511, P<0.001) and was lower than CT-ASPECTS (median 8 [interquartile range, 6 to 9] versus 9 [8 to 10], P<0.001). Higher baseline National Institutes of Health Stroke Scale score (standardized partial regression coefficient [β] 0.061, P<0.001) and cardioembolic stroke (β 0.35, P<0.001) were related to this discrepancy. The area under the receiver operating characteristic curve for predicting sICH (12 patients) using ASPECTS was 0.673 (95% CI, 0.503 to 0.807) by CT and 0.764 (95% CI, 0.635 to 0.858) by DWI (P=0.275). The area for predicting independence at 3 months (192 patients) was 0.621 (0.564 to 0.674) by CT and 0.639 (0.580 to 0.694) by DWI (P=0.535). CONCLUSIONS: For patients with hyperacute stroke, DWI-ASPECTS scored approximately 1 point lower than CT-ASPECTS. Both CT-ASPECTS and DWI-ASPECTS were useful predictors of symptomatic intracerebral hemorrhage and independence at 3 months after recombinant tissue-type plasminogen activator.
Authors:
Tomohisa Nezu; Masatoshi Koga; Jyoji Nakagawara; Yoshiaki Shiokawa; Hiroshi Yamagami; Eisuke Furui; Kazumi Kimura; Yasuhiro Hasegawa; Yasushi Okada; Satoshi Okuda; Kazuomi Kario; Masaki Naganuma; Koichiro Maeda; Kazuo Minematsu; Kazunori Toyoda
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-30
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-7-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; the Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan; the Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan; the Stroke Center, Kobe City Medical Center General Hospital, Kobe, Japan; the Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan; the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan; the Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan; the Department of Cerebrovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; the Department of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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