Modified diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score including deep white matter lesions predicts symptomatic intracerebral hemorrhage following intravenous thrombolysis.
Aged
Brain Infarction
/ diagnosis
Cerebral Hemorrhage
/ diagnosis
Diffusion Magnetic Resonance Imaging
/ methods
Female
Fibrinolytic Agents
/ administration & dosage
Humans
Ischemic Stroke
/ diagnosis
Japan
Male
Patient Selection
Predictive Value of Tests
Prognosis
Risk Adjustment
/ methods
Thrombolytic Therapy
/ adverse effects
Tissue Plasminogen Activator
/ administration & dosage
Tomography, X-Ray Computed
/ methods
White Matter
/ diagnostic imaging
Alberta Stroke Program Early Computed Tomography Score
Diffusion-weighted imaging
Ischemic stroke
Symptomatic intracerebral hemorrhage
Thrombolysis
Journal
Journal of thrombosis and thrombolysis
ISSN: 1573-742X
Titre abrégé: J Thromb Thrombolysis
Pays: Netherlands
ID NLM: 9502018
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
pubmed:
21
11
2019
medline:
10
4
2021
entrez:
21
11
2019
Statut:
ppublish
Résumé
The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used for the assessment of early ischemic changes (EICs) before thrombolysis. However, for symptomatic intracerebral hemorrhage (sICH) following intravenous recombinant tissue plasminogen activator (rt-PA), the prediction abilities of CT-ASPECTS, diffusion-weighted imaging (DWI)-ASPECTS, and DWI-ASPECTS including EICs in deep white matter (DWI-ASPECTS + W) are unclear. We investigated associations between each score and sICH following intravenous rt-PA. Data from consecutive patients who received intravenous rt-PA for acute ischemic stroke from 2005 to 2015 in four hospitals were retrospectively screened. We included data from patients who had undergone both CT and magnetic resonance imaging before thrombolysis and without evidence of posterior circulation stroke. We analyzed the ability of CT-ASPECTS, DWI-ASPECTS, and DWI-ASPECTS + W to predict sICH, accompanied by an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 4 within the initial 36 h. Of 455 patients (273 men, median 75 years old), sICH occurred in 15 patients (3.3%). Receiver operating characteristics curve analysis showed that the optimal cut-offs of CT-ASPECTS, DWI-ASPECTS, and DWI-ASPECTS + W for predicting sICH were ≤ 9 (sensitivity 60.0%, specificity 59.8%, c-statistic 0.625), ≤ 6 (sensitivity 53.3%, specificity 80.9%, c-statistic 0.718), and ≤ 8 (sensitivity 86.7%, specificity 55.9%, c-statistic 0.756), respectively. A DWI-ASPECTS + W of ≤ 8 was independently associated with sICH (odds ratio 5.21, 95% confidence interval 1.30-35.31) after adjustment for pretreatment with antithrombotic agents, pretreatment NIHSS score, and large artery occlusions. DWI-ASPECTS + W predicted sICH in patients with acute anterior circulation stroke receiving intravenous rt-PA.
Identifiants
pubmed: 31745858
doi: 10.1007/s11239-019-01979-7
pii: 10.1007/s11239-019-01979-7
pmc: PMC7293975
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
174-180Subventions
Organisme : Japan Society for the Promotion of Science
ID : 19K21303
Organisme : Japan Society for the Promotion of Science
ID : 16K10727
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