Satrirat JantasriUdonthani Hospital, Thailand
Title: Association of pretreatment ASPECTS scores with predicting effectiveness of intravenous rtPa in acute Middle Cerebral Artery infarction in Udonthani Hospitalin NTRK Fusion-Positive HighGrade Glioneuronal Tumor: A Case Report
Udonthani stroke network was expanded to community hospital as node-rtPA. But node rtPA had higher rate of post-rtPA symptomatic intracerebral hemorrhage (sICH) than Udonthani hospital (11.2% vs 6.7%). 58% of Post-rtPA sICH in node-rtPA were large cerebral infarction. Alberta Stroke Program Early CT-Score (ASPECTS) is practical method for appraising patients with acute Middle Cerebral Artery (MCA) infarction. To assess association between pretreatment ASPECTS and effectiveness of rtPA treatment in acute MCA Infarction. Adult patients with acute MCA infarction treated with rtPA at Udonthani hospitals between January 1st, 2020 and December 31th, 2020 were included and divided into two groups: ASPECTS ? 6 and ASPECTS > 6. Outcomes were good functional outcome (mRS 0-1), poor functional outcome (mRS 2-6) and post-rtPA sICH. Factors associated with outcomes were executed by multiple logistic regression analysis. 86 patients were studied. ASPECTS ? 6 group had non-significant lower rate of good functional outcome than ASPECTS > 6 group (9.1% vs 53.3 %; adjusted OR 0.24, P = 0.221). No significant factors associated with good functional outcome. ASPECTS ? 6 group had non-significant higher rate of poor functional outcome than ASPECTS > 6 group (90.9% vs 46.7%; adjusted OR = 4.24, P = 0.221). Statistically non-significant factors associated with poor functional outcome included ASPECTS ? 6, Hyperdense MCA sign, AF and More severity. ASPECTS ? 6 group had non-significant higher rate of post-rtPA sICH than ASPECTS > 6 group (27.3% vs 6.7%; adjusted OR 1.25, P = 0.855). Statistically non-significant predictors for post rtPA sICH included ASPECTS ? 6, Hyperdense MCA sign and vulvular heart disease. ASPECTS ? 6 predicted poor functional outcome (mRS 2–6) and post-rtPA sICH, statistically non-significant. However, developing CT brain interpretation skills with ASPECTS are helpful in post-rtPA sICH prediction and are vital elements for making improvements to the Udonthani stroke service system.
Satrirat Jantasri, diplomate, thai board of neurology. She is a neurologist at Udonthani Hospital, in Northeastern Thailand. She is a medical doctor, at expert level, the head of the division of neurology, department of Medicine, Udonthani Hospital, Thailand. And now, she is holding the position of chairman of the Udonthani Stroke Fast Track Network, Chairman of the Stroke Service Provider Board, Health Region 8, Ministry of Public Health, Thailand. She developed the Udonthani Stroke Fast Track Network and Udonthani Hospital has been treating Acute Ischemic Stroke patients with standard treatment using intravenous rtPA since 1 October 2010. She intended to develop a stroke service system, with the aim of expanding the standard treatment with intravenous rtPA cover all patients with acute ischemic stroke in Udonthani and Health Region 8.