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Pretreatment ASPECTS on DWI predicts 3-month outcome following rt-PA

Objective: To evaluate whether the pretreatment Alberta Stroke Programme Early CT Score (ASPECTS) assessed using diffusion-weighted imaging (DWI) predicts stroke outcomes at 3 months following IV recombinant tissue-type plasminogen activator (rt-PA) therapy. Methods: Stroke patients treated with rt-PA (0.6 mg/kg alteplase) in 10 stroke centers in Japan were retrospectively studied. ASPECTS was assessed on DWI just prior to rt-PA injection. The primary outcome was a modified Rankin Scale (mRS) score of 0–2 at 3 months. Secondary outcomes included death at 3 months and symptomatic intracerebral hemorrhage (sICH) within 36 hours. Results: For the 477 patients (316 men, 71 ± 11 years old) enrolled, the median NIH Stroke Scale score was 13 (interquartile range 7–18.5), the median ASPECTS on DWI was 8 (7–10), and sICH was identified in 15 patients (3.1%). At 3 months, 245 (51.4%) had an mRS score of 0–2, and 29 (6.1%) had died. Patients with an mRS score of 0–2 had higher median ASPECTS (9; interquartile range 8–10) than other patients (8; 6–9, p < 0.001). Using receiver operating characteristic curves, the optimal cutoff ASPECTS to predict an mRS score of 0–2 was ≥7. On multivariate regression analysis, ASPECTS ≥7 was related to an mRS score of 0–2 (odds ratio 1.85; 95% confidence interval 1.07–3.24), ASPECTS ≤4 was related to death (3.61; 1.23–9.91), and ASPECTS ≤5 was related to sICH (4.74; 1.54–13.64). Conclusion: ASPECTS on DWI was independently predictive of functional and vital outcomes at 3 months, as well as sICH within 36 hours, following rt-PA therapy for stroke patients.