Background and Purpose -The importance of early ischemic change (EIC) on baseline computed tomography (CT) in the decision to thrombolyze the patient with acute ischemic stroke has been controversial. ASPECTS is a sem...Background and Purpose -The importance of early ischemic change (EIC) on baseline computed tomography (CT) in the decision to thrombolyze the patient with acute ischemic stroke has been controversial. ASPECTS is a semiquantitative scale that scores the extent of EIC within the middle cerebral artery territory. We examined whether ASPECTS could be a treatment modifier by systematically reviewing the CT scans in the NINDS rtPA Stroke Study. Methods -Six hundred eight of the 624 CT scans were available and of sufficient quality. One of 2 teams (n=3 each) of expert ASPECTS readers evaluated each scan for an ASPECTS value using a con sensus score approach. Each team was blind to all clinical information except symptom side and blind to follow-up imaging and outcome information. ASPECTS values were stratified before analysis. Multivariable logistic regression was used to determine if an ASPECTS by treatment interaction existed on treatment response, outcome, and intracerebral hemorrhage risk. Results -A total of 57.2%(348 of 608) of scans showed EIC with an ASPECTS < 10. ASPECTS dichotomized into 8 to 1 0 and < 8 did not have a treatment-modifying effect on good outcome but showed a trend to lower mortality at 90 days with tPA (relative risk 0.67, 95%confidence interval 0.41 to 1.06, P=0.10). ASPECTS 8 to 10 were associated with a trend to larger benefit of tPA with a number needed to treat (NNT) of 5 versus ASPECTS 3 to 7 with a NNT of 8. Conclusion -There was no evidence of treatment effect modification by the baseline ASPECTS value in the NINDS rtPA Stroke Study. There fore, exclusion of patients for thrombolysis within 3 hours of symptom onset based on EIC is not supported by our data. There is a trend to reduced mortality and increased benefit to rtPA if the baseline CT scan is favorable (ASPECTS >7).展开更多
5月16日的Yahoo上刊登了此文,读后我非常兴奋。把它介绍给我的朋友和同事。他们觉得此文传递的信息十分重要,建议我将此文作为注释读物发给贵刊。Stroke,汉语称之为“中风”,在当今之美国,是第三大死因。许多患者本人对中风的病症了解甚...5月16日的Yahoo上刊登了此文,读后我非常兴奋。把它介绍给我的朋友和同事。他们觉得此文传递的信息十分重要,建议我将此文作为注释读物发给贵刊。Stroke,汉语称之为“中风”,在当今之美国,是第三大死因。许多患者本人对中风的病症了解甚少,许多bystanders对中风病人的发病状态和急救方式也知之不多,因此,原本可以得救的病人就白白错过了救治良机。在美国首都的NINDS(全国神经紊乱及中风协会)在今年五月开展了一场运动,运动的名称为:Know Stroke: Know the Signs,Act in Time(是否可译:认识中风:了解症状,及时采取救治行动)。此运动可以让患者掌握更多的治疗处置中风病的知识。同时,又能让bystanders懂得救治的正确方法。NINDS的负责人如此幽默地说:This is a bystander's chance to be a hero,because you really can save a life with the right information. 文章除了提供了加强自我保健,避免罹患中风之外,还告诉我们中风发作之前的症状。这些症状一共有五条。希望读者朋友细读勤记,说不准哪一天,这些从杂志上得来的知识派上了大用场,让你成了a hero!本文的文字不错,尤其值得玩味的一个词是needlessly(见倒数第二行),作为non native-speaker,似乎很难如此使用此副词。展开更多
文摘Background and Purpose -The importance of early ischemic change (EIC) on baseline computed tomography (CT) in the decision to thrombolyze the patient with acute ischemic stroke has been controversial. ASPECTS is a semiquantitative scale that scores the extent of EIC within the middle cerebral artery territory. We examined whether ASPECTS could be a treatment modifier by systematically reviewing the CT scans in the NINDS rtPA Stroke Study. Methods -Six hundred eight of the 624 CT scans were available and of sufficient quality. One of 2 teams (n=3 each) of expert ASPECTS readers evaluated each scan for an ASPECTS value using a con sensus score approach. Each team was blind to all clinical information except symptom side and blind to follow-up imaging and outcome information. ASPECTS values were stratified before analysis. Multivariable logistic regression was used to determine if an ASPECTS by treatment interaction existed on treatment response, outcome, and intracerebral hemorrhage risk. Results -A total of 57.2%(348 of 608) of scans showed EIC with an ASPECTS < 10. ASPECTS dichotomized into 8 to 1 0 and < 8 did not have a treatment-modifying effect on good outcome but showed a trend to lower mortality at 90 days with tPA (relative risk 0.67, 95%confidence interval 0.41 to 1.06, P=0.10). ASPECTS 8 to 10 were associated with a trend to larger benefit of tPA with a number needed to treat (NNT) of 5 versus ASPECTS 3 to 7 with a NNT of 8. Conclusion -There was no evidence of treatment effect modification by the baseline ASPECTS value in the NINDS rtPA Stroke Study. There fore, exclusion of patients for thrombolysis within 3 hours of symptom onset based on EIC is not supported by our data. There is a trend to reduced mortality and increased benefit to rtPA if the baseline CT scan is favorable (ASPECTS >7).
文摘5月16日的Yahoo上刊登了此文,读后我非常兴奋。把它介绍给我的朋友和同事。他们觉得此文传递的信息十分重要,建议我将此文作为注释读物发给贵刊。Stroke,汉语称之为“中风”,在当今之美国,是第三大死因。许多患者本人对中风的病症了解甚少,许多bystanders对中风病人的发病状态和急救方式也知之不多,因此,原本可以得救的病人就白白错过了救治良机。在美国首都的NINDS(全国神经紊乱及中风协会)在今年五月开展了一场运动,运动的名称为:Know Stroke: Know the Signs,Act in Time(是否可译:认识中风:了解症状,及时采取救治行动)。此运动可以让患者掌握更多的治疗处置中风病的知识。同时,又能让bystanders懂得救治的正确方法。NINDS的负责人如此幽默地说:This is a bystander's chance to be a hero,because you really can save a life with the right information. 文章除了提供了加强自我保健,避免罹患中风之外,还告诉我们中风发作之前的症状。这些症状一共有五条。希望读者朋友细读勤记,说不准哪一天,这些从杂志上得来的知识派上了大用场,让你成了a hero!本文的文字不错,尤其值得玩味的一个词是needlessly(见倒数第二行),作为non native-speaker,似乎很难如此使用此副词。
