Stroke：DWI-ASPECTS能够预测大脑中动脉梗塞患者tPA溶栓后早期效果

弥散加权成像和Alberta卒中计划早期CT评分（DWI-ASPECTS）是评价梗塞范围和严重程度的重要评分标准。对于大脑中动脉主干梗塞的患者，可能可以预测静脉用重组组织纤溶酶原激活剂（静脉溶栓）后短期神经功能恢复情况。为此，日本川崎医学院神经科的Junya Aoki博士等人进行了一项研究，研究结果在线发表在2012年12月4日的Stroke杂志上。研究结果发现：DWI-ASPECTS能够预测大脑中动脉主干梗塞患者静脉注射重组组织纤溶酶原激活剂后短期恢复情况。

研究人员共纳入66位患者（中位年龄[四分位], 79 [70–85] 岁, 其中男性34 [52%])。将显着恢复定义为发病后24小时和7天，NIHSS评分减少≥10分，或为0-1分。早期再通定义为静脉用重组组织纤溶酶原激活剂后1小时内血管再通。有利结果定义为3个月的改良Rankin评分得分0-2分。

研究结果显示：DWI-ASPECTS为6（5-9）。发病后24小时和发病后7天的显着恢复人数分别为16（24%）和26（39%）。22位（33%）的患者出现了早期再通。DWI-ASPECTS≥7 是发病后24小时(风险比：100.85;95%可信区间：4.29–2371.40; P=0.004)和发病后7天(风险比：14.15; 95%可信区间：2.21–90.48; P=0.005)显着恢复的独立预测因素。

该研究显示：DWI-ASPECTS能够预测大脑中动脉主干梗塞患者静脉注射重组组织纤溶酶原激活剂后短期恢复情况。对于DWI-ASPECTS得分低的患者，仍有可能因早期再通获益。

doi: 10.1161/​STROKEAHA.112.675470
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DWI-ASPECTS as a Predictor of Dramatic Recovery After Intravenous Recombinant Tissue Plasminogen Activator Administration in Patients With Middle Cerebral Artery Occlusion.

Junya Aoki, MD, Kazumi Kimura, MD, Kensaku Shibazaki, MD and Yuki Sakamoto, MD

Background and Purpose—In patients with middle cerebral artery trunk occlusion we investigated whether the diffusion-weighted imaging- the Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) predicts short-term neurological recovery after intravenous recombinant tissue plasminogen activator administration, and investigated how DWI-ASPECTS relates to clinical outcome. Methods—Dramatic recovery was defined as a ≥10-point reduction or a total National Institutes of Health Stroke Scale score of 0 to 1 at 24 hours and 7 days. Early recanalization was defined as recanalization within 1 hours after intravenous recombinant tissue plasminogen activator. Favorable outcome at 3 months was defined as a modified Rankin Scale score of 0 to 2. Results—Sixty-six patients (median age [interquartile], 79 [70–85] years, male; 34 [52%]) were enrolled. DWI-ASPECTS was 6 (5–9). Dramatic recovery was seen in 16 (24%) and 26 (39%) patients at 24 hours and on day 7, respectively. Early recanalization occurred in 22 (33%) patients. DWI-ASPECTS ≥7 was an independent predictor of dramatic recovery at 24 hours (odds ratio, 100.85; 95% confidence interval, 4.29–2371.40; P=0.004) and 7 days (odds ratio, 14.15; 95% confidence interval, 2.21–90.48; P=0.005). Although the favorable outcome rate was not significantly different between patients with DWI-ASPECTS ≥7 with and without early recanalization (60% versus 31%; P=0.228), it was statistically more frequent in patients with DWI-ASPECTS <7 with early recanalization than those without early recanalization (38% versus 0%; P=0.017). Conclusions—DWI-ASPECTS predicted short-term recovery in patients with middle cerebral artery trunk occlusion receiving intravenous recombinant tissue plasminogen activator. In patients with lower DWI-ASPECTS, there may still be benefit from early recanalization.