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How well does ASPECTS predict the outcome of acute stroke treated with IV tPA?

From the Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.

Address correspondence and reprint requests to Prof. Alastair M. Buchan, Nuffield Department of Clinical Medicine, Level 7, John Radcliffe Hospital, Headington, Oxford, UK OX3 9DU; e-mail: alastair.buchan{at}ndm.ox.ac.uk

The authors measured the association of early ischemic change on CT scan, measured using the Alberta Stroke Programme Early CT score (ASPECTS), and functional outcome in 825 patients with anterior circulation stroke treated with IV thrombolysis within 3 hours of onset. ASPECTS predicted outcome in a graded fashion (linearly for ASPECTS 6 through 10; pattern ill-defined for ASPECTS 0 through 5) but discriminated individual outcomes weakly. Except perhaps when early ischemic change is extensive, clinicians should not estimate prognosis using ASPECTS alone.

*Canadian Activase for Stroke Effectiveness Study.

Disclosures: This study received no direct funding support. However, CASES was funded cooperatively by the Canadian Stroke Consortium, the Canadian Stroke Network, and Hofman-La Roche Canada Ltd. M.D.H. was funded in part by the Heart and Stroke Foundation of Alberta/NWT/NU, the Canadian Institutes for Health Research, and the Alberta Heritage Foundation for Medical Research. A.M.B. was funded in part by the Heart and Stroke Foundation of Alberta/NWT/NU, the Alberta Heritage Foundation for Medical Research, and the Canadian Institutes for Health Research. The Calgary Stroke Program has previously published widely about the value of using ASPECTS to quantify early ischemic change in the context of hyperacute stroke. None of the authors have themselves received financial support from or have equity positions in manufacturers of tissue plasminogen activator.

Received January 3, 2005. Accepted in final form March 28, 2006.

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