Abstract
BackgroundClinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy.MethodsBrain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admission NIHSS—baseline NIHSS score), symptomatic intracranial hemorrhage (sICH), mortality, and favorable outcome at 3 months.ResultsPatients in the P group had a greater proportion of favorable outcome at 3 months (p = 0.032) and more frequent ENI (p = 0.038) and a greater delta NIHSS score (p = 0.001), as well as a lower proportion of END (p = 0.004) than those in the N group patients. There were no significant differences in the incidence rates of sICH and mortality between the two groups.ConclusionsClinical-CT mismatch may be able to predict which patients would benefit from intravenous thrombolysis.
Highlights
The term penumbra refers to a region of hypoperfused but potentially salvageable brain tissue in cases of acute ischemic stroke [1]
A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score 8 and a computed tomography (CT)-Alberta Stroke Program Early CT Score (ASPECTS) 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative
There were no significant differences in the incidence rates of symptomatic intracranial hemorrhage (sICH) and mortality between the two groups
Summary
Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. We hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may predict the responses to thrombolytic therapy
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