Article Figures & Data
Figures
- Fig 1.
A, Baseline CT scan at 100 minutes from stroke onset showing a left middle cerebral artery infarct with an ASPECT score of 8. Points are taken off for hypoattenuation of the head of caudate and the lentiform nuclei. Based upon our data, this patient would be an ideal candidate for IV-IA therapy.
B, Baseline CT scan at 175 minutes from stroke onset showing a well-evolved right middle cerebral artery infarct with an ASPECT score of 0. Based upon our data, this patient could be harmed by IV-IA therapy.
- Fig 2.
Modified Rankin Scale outcomes at 90 days stratified by the baseline ASPECT score and adjusted using ordered logistic regression for baseline age, NIH Stroke Scale score, onset-to-treatment time, and baseline serum glucose.
Tables
Placebo (N = 208)* IV tPA (N = 172)* IV-IA tPA (N = 80)† P Median (iqr) Baseline Age 66 (58–72) 69 (59–74) 65 (54.5–75) .229 Gender (% female) 44 42 50 .513 bNIHSS 17 (13–22) 17 (14–21) 18 (14–21) .857 Glucose (mM) 7.0 (6.0–8.75) 6.9 (5.8–9.5) 6.2 (5.6–7.3) .0098 bASPECTS 8 (6–10) 8 (6–10) 7 (4–9) .0003 bASPECTS > 7 (%) 62.5 57.0 37.5 .001 Onset-to-treat time (min) 108.5 (89–150) 90 (88–149) 140 (110–158) <.001 Outcomes Death (%) 24 20 16 .361 mRS 0–1 (%) 18 33 30 .002 mRS 0–2 (%) 28 40 43 .016 NIHSS 0–1 (%) 15 25 28 .013 sICH (%) 0.96 5.2 6.3 .014 Note:—tPA indicates tissue plasminogen activator; iqr, interquartile range; bNIHSS, baseline National Institutes of Health Stroke score; ASPECTS, Alberta Stroke Program Early CT score; bASPECTS, baseline ASPECT score; mRS, modified Rankin Scale; sICH, symptomatic intracerebral hemorrhage.
* From a subset of the NINDS tPA Stroke Study.
† From the IMS-1 Trial.
Variable Outcome mRS 0–1 NIHSS 0–1 OR (CI) P OR (CI) P Interaction ASPECTS > 7 by treatment 1.8 (0.92–3.5) .084 2.1 (1.1–4.2) .036 Age (y) 0.95 (0.93–0.97) <.0001 0.95 (0.93–0.97) <.0001 Baseline NIHSS 0.86 (0.82–0.91) <.0001 0.86 (0.81–0.91) <.0001 Onset-to-treatment time (min) 0.99 (0.99–1.003) .349 0.99–1.001 .118 Glucose (mM) 0.95 (0.90–1.01) .132 0.97 (0.90–1.03) .305 Note:—mRS indicates modified Rankin Scale; ASPECTS, Alberta Stroke Program Early CT score; NIHSS, National Institutes of Health Stroke Scale Score; OR, odds ratio. The interpretation of the OR of an interaction term in a logistic regression model is not intuitive or necessarily meaningful clinically. The statistical significance of the interaction term implies that there is a differential treatment effect according to whether the baseline CT scan is favorable or unfavorable. In the presence of an interaction, the OR of the main effects variables are also not clinically meaningful and therefore are excluded from the table. As in previous analyses, age and baseline stroke severity are strong prognostic factors.
- Table 3:
ASPECT scores according to intracranial arterial lesion location for the IMS-1 cohort
Occlusion Location (n) ASPECTS (median, iqr) ASPECTS > 7 (%, n/N) Outcome: mRS 0–1 (%, n/N) ASPECTS > 7 ASPECTS ≤ 7 Carotid T (15) 4 (3–7) 13% (2/15) 0% (0/2) 0% (0/13) M1 (26) 6 (4–8) 31% (8/26) 50% (4/8) 17% (3/18) M2 (20) 7 (5–9.5) 45% (9/20) 33% (3/9) 36% (4/11) M3 (6) 7 (5–9) 33% (2/6) 50% (1/2) 50% (2/4) None (6) 10 (9–10) 83% (5/6) 60% (3/5) 100% (1/1) ACA (2) 6.5 (3–10) 50% (1/2) 0% (0/1) 100% (1/1) VB (2) 8.5 (8–9) 100% (2/2) 50% (1/2) — Note:—Three patients did not undergo angiography and thus lesion location was not determined. Intracranial arterial lesion location was determined independent of any extracranial artery occlusion. T indicates carotid T occlusion; M1, M1 segment middle cerebral artery; M2, M2 segment middle cerebral artery; M3, M3 segment middle cerebral artery; ACA, anterior cerebral artery; VB, vertebrobasilar arteries; ASPECTS, Alberta Stroke Program Early CT score; mRS, modified Rankin Scale score; iqr, interquartile range.
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