• Teruyuki Hirano, Makoto Sasaki, Noriaki Tomura, Yasunobu Ito, Shotai Kobayashi, and Japan Alteplase Clinical Trial Group.
• Department of Neurology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. terry07@kumamoto-u.ac.jp
• J Stroke Cerebrovasc Dis. 2012 Nov 1;21(8):898-902.

BackgroundThe significance of early ischemic changes (EICs) on computed tomography (CT) in selecting candidates for thrombolysis remains controversial. The Alberta Stroke Program Early CT Score (ASPECTS) provides a semiquantitative scale that scores EICs within the middle cerebral artery territory using a 10-point grading system. We examined whether ASPECTS can predict the response to intravenous thrombolysis within 3 hours of stroke onset and incidence of secondary hemorrhage.MethodsData from the Japan Alteplase Clinical Trial (J-ACT), in which 103 patients were included, were evaluated to assess the efficacy and safety of 0.6 mg/kg alteplase within 3 hours. All CT hardcopies were reevaluated retrospectively using the ASPECTS system. Multivariate logistic regression analysis was undertaken to determine whether an effect of ASPECTS existed on a defined favorable outcome as 0 or 1 on the modified Rankin Scale at 3 months, and symptomatic intracranial hemorrhage (sICH) within 36 hours.ResultsThe median ASPECTS value was 10 (range 3 to 10), and 56.3% revealed no evidence of EICs. ASPECTS had no effect on the patients' outcome, although a higher age and National Institutes of Health Stroke Scale score were negatively associated with a favorable outcome. On the other hand, lower ASPECTS was significantly associated with sICH (odds ratio [OR] 2.224; 95% confidence interval [CI] 1.227-4.032; P = .0084) and systolic blood pressure (OR 1.090; 95% CI 1.007-1.180; P = .0323) and the pre-ictal use of antiplatelet medications (OR 15.551; 95% CI 1.144-211.374; P = .0393).ConclusionsIn J-ACT, patients with low ASPECTS values have an increased risk of thrombolysis-related sICH.Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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