J Stroke.  2017 Sep;19(3):340-346. 10.5853/jos.2016.01424.

Visibility of CT Early Ischemic Change Is Significantly Associated with Time from Stroke Onset to Baseline Scan beyond the First 3 Hours of Stroke Onset

Affiliations
  • 1Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia. andrew.bivard@newcastle.edu.au
  • 2Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitake, Tokyo, Japan.
  • 3Centre for Bioinformatics, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.

Abstract

BACKGROUND AND PURPOSE
Non-contrast brain computed tomography (NCCT) remains the most common imaging modality employed to select patients for thrombolytic therapy in acute ischemic stroke. The current study used the Alberta Stroke Program Early CT Score (ASPECTS) to identify early ischemic changes on brain NCCT imaging with the aim to investigate whether a relationship exists between time from symptoms onset to NCCT with the presence of early ischaemic change quantified by ASPECTS.
METHODS
We studied 1,329 ischemic stroke patients who had NCCT within 8 hours of stroke onset. Patients were assessed to see if they had any ASPECTS lesion and if the rate of patients with a lesion increased with time using logistic regression.
RESULTS
30% patients had an ASPECTS < 10 within the first 3 hours from symptom onset. Within the first 3 hours, the odds for a CT change (ASPECTS < 10) per minute of time was 1.00 with 95% confidence interval (CI) (0.99 to 1.00) (P=0.266). After 3 hours, there was a significant increase in odds of ASPECTS < 10 with increasing time. The odds of being ASPECTS positive increased 1% (odds ratio=1.01) per 1 minute of time with 95% CI (1.00 to 1.01) (P=0.002).
CONCLUSIONS
We have identified that prior to first 3 hours of stroke there was no effect of time on odds of CT ischemic change; after the first 3 hours of stroke the odds increased with increasing time to CT scan. The occurrence of early ischemic change may be a marker of time from stroke onset rather than severity.

Keyword

Stroke; Tomography, X-ray computed; Time

MeSH Terms

Alberta
Brain
Humans
Logistic Models
Stroke*
Thrombolytic Therapy
Tomography, X-Ray Computed
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