Value Of DWI-aspects In Predicting Outcomes Of Intravenous Thrombolysis Treated Patients With Acute Anterior Circulation Cerebral Infarction

Objectives To study the value of DWI-ASPECTS in predicting outcomes of intravenous thrombolysis treated patients with AACCI,and provide a basis for its application in clinical practice.Methods 99 cases from June 2015 to December 2016 in North China University of Science and Technology Affiliated Hospital neurology ICU received rt-PA intravenous thrombolysis in patients of acute cerebral infarction were collected.The clinical data,DWI-ASPECTS score,thrombolysis in 3 months after the modified Rankin scale(m RS)thrombolysis,3 months after the modified Barthel index(MBI)and no blood vessel occlusion,hemorrhage,ischemia reperfusion injury and other complications of thrombolysis.According to the m RS score after 3 months of thrombolysis,the score was divided into 2 groups: m RS 0~2 was divided into good outcome group,66 cases were in total,and 3~6 was bad outcome group,with 33 cases.The difference of clinical and imaging data between the 2 groups was compared.The influencing factors of prognosis of acute anterior circulation cerebral infarction were screened,and the predictive value of DWI-ASPECTS score for prognosis of acute anterior circulation cerebral infarction patients undergoing intravenous thrombolysis was evaluated.Results The age was younger(72.68vs76.51;P = 0.012),the NIHSS score was significantly lower(9.12vs16.52;P = 0.000)while the NIHSS score was significantly higher(7.14vs4.24;P = 0.000)in good outcome group than in poor outcome group on admission(P < 0.05).Logistic regression analysis showed that age(OR = 1.097,95%CI: 1.019~1.180,P = 0.013),NIHSS score(OR = 1.207,95%CI: 1.025~1.421,P = 0.024)and DWI-ASPECTS score(OR = 0.543,95%CI: 0.343 ~ 0.858,P =0.009)on admission were the independent predictors for poor outcomes of intravenous thrombolysistreated AACCI patients(P < 0.05).The DWI-ASPECTS score was positively related with the MBI(r = 0.695,P = 0.000).The DWI-ASPECTS score was related with the blood vessel reocclusion(C = 0.460,P = 0.000),hemorrhage(C = 0.436,P = 0.000),and I/R injury(C = 0.525,P = 0.000).The area under the ROC curve for DWI-ASPECTS score was 0.887.The best critical value of DWI-ASPECTS in predicting the outcome of intravenous thrombolysis-treated AACCI patients was 6 with a sensitivity of 84.8% and a specificity of 81.8%.Conclusions 1 Age,the NIHSS score and the DWI-ASPECTS score were all the factors affecting the prognosis of the patients with acute anterior cerebral infarction.2 DWIASPECTS score is an important index to evaluate the prognosis of patients with acute anterior circulation cerebral infarction treated by intravenous thrombolysis,and has good correlation with prognosis.It can be widely applied in clinic.3 DWI-ASPECTS score predicted that the threshold value of venous thrombolysis in acute anterior circulation cerebral infarction was 6 points,that is,patients whose DWI-ASPECTS score higher than 6 points had better outcome than those whose DWI-ASPECTS score lower than 6 points.