Distance to Thrombus in Acute Middle Cerebral Artery Occlusion: A Predictor of Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke
BACKGROUND AND PURPOSE—In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) usin...
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| Veröffentlicht in: | Stroke (1970) 2015-03, Vol.46 (3), p.692-696 |
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| container_title | Stroke (1970) |
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| creator | Friedrich, Benjamin Gawlitza, Matthias Schob, Stefan Hobohm, Carsten Raviolo, Mariana Hoffmann, Karl-Titus Lobsien, Donald |
| description | BACKGROUND AND PURPOSE—In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion.
METHODS—Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed.
RESULTS—DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was |
| doi_str_mv | 10.1161/STROKEAHA.114.008454 |
| format | Article |
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METHODS—Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed.
RESULTS—DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001).
CONCLUSION—DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.114.008454</identifier><identifier>PMID: 25649802</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Angiography ; Carotid Arteries - pathology ; Female ; Fibrinolytic Agents - therapeutic use ; Humans ; Infarction, Middle Cerebral Artery - physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Stroke - drug therapy ; Thrombolytic Therapy - methods ; Thrombosis - diagnostic imaging ; Thrombosis - physiopathology ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>Stroke (1970), 2015-03, Vol.46 (3), p.692-696</ispartof><rights>2015 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3754-3e8d628908c44cf48a2a938a30d40973b544b3448bc0f9c09f96fac92fb827b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25649802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Friedrich, Benjamin</creatorcontrib><creatorcontrib>Gawlitza, Matthias</creatorcontrib><creatorcontrib>Schob, Stefan</creatorcontrib><creatorcontrib>Hobohm, Carsten</creatorcontrib><creatorcontrib>Raviolo, Mariana</creatorcontrib><creatorcontrib>Hoffmann, Karl-Titus</creatorcontrib><creatorcontrib>Lobsien, Donald</creatorcontrib><title>Distance to Thrombus in Acute Middle Cerebral Artery Occlusion: A Predictor of Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>BACKGROUND AND PURPOSE—In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion.
METHODS—Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed.
RESULTS—DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001).
CONCLUSION—DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>Carotid Arteries - pathology</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Infarction, Middle Cerebral Artery - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Stroke - drug therapy</subject><subject>Thrombolytic Therapy - methods</subject><subject>Thrombosis - diagnostic imaging</subject><subject>Thrombosis - physiopathology</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi1ERZfCGyDkI5cUx5lkbW7RUuiKVlu1yzlynLHW1ImL7VDtU_DKGKX0yMka6ZtvPPMT8q5k52XZlB_v9re7bxftZZtLOGdMQA0vyKqsORTQcPGSrBirZMFBylPyOsYfjDFeifoVOeV1A1IwviK_P9uY1KSRJk_3h-DHfo7UTrTVc0J6bYfBId1gwD4oR9uQMBzpTms3R-unT7SlNwEHq5MP1Bu6m5P2I9LWZJBupxTUL5x8di5y747RRmoyvUzYRn3A0Wp6l4K_xzfkxCgX8e3Te0a-f7nYby6Lq93X7aa9KnS1rqGoUAx5R8mEBtAGhOJKVkJVbAAm11VfA_QVgOg1M1IzaWRjlJbc9IKv-7I6Ix8W70PwP2eMqRtt1OicmjD_tiubWqyZyIqMwoLq4GMMaLqHYEcVjl3Jur9RdM9R5BK6JYrc9v5pwtyPODw3_bt9BsQCPHqXjxXv3fyIoTugcunwf_cfxPSYnA</recordid><startdate>201503</startdate><enddate>201503</enddate><creator>Friedrich, Benjamin</creator><creator>Gawlitza, Matthias</creator><creator>Schob, Stefan</creator><creator>Hobohm, Carsten</creator><creator>Raviolo, Mariana</creator><creator>Hoffmann, Karl-Titus</creator><creator>Lobsien, Donald</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201503</creationdate><title>Distance to Thrombus in Acute Middle Cerebral Artery Occlusion: A Predictor of Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke</title><author>Friedrich, Benjamin ; Gawlitza, Matthias ; Schob, Stefan ; Hobohm, Carsten ; Raviolo, Mariana ; Hoffmann, Karl-Titus ; Lobsien, Donald</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3754-3e8d628908c44cf48a2a938a30d40973b544b3448bc0f9c09f96fac92fb827b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography</topic><topic>Carotid Arteries - pathology</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Infarction, Middle Cerebral Artery - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Stroke - drug therapy</topic><topic>Thrombolytic Therapy - methods</topic><topic>Thrombosis - diagnostic imaging</topic><topic>Thrombosis - physiopathology</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Friedrich, Benjamin</creatorcontrib><creatorcontrib>Gawlitza, Matthias</creatorcontrib><creatorcontrib>Schob, Stefan</creatorcontrib><creatorcontrib>Hobohm, Carsten</creatorcontrib><creatorcontrib>Raviolo, Mariana</creatorcontrib><creatorcontrib>Hoffmann, Karl-Titus</creatorcontrib><creatorcontrib>Lobsien, Donald</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Friedrich, Benjamin</au><au>Gawlitza, Matthias</au><au>Schob, Stefan</au><au>Hobohm, Carsten</au><au>Raviolo, Mariana</au><au>Hoffmann, Karl-Titus</au><au>Lobsien, Donald</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distance to Thrombus in Acute Middle Cerebral Artery Occlusion: A Predictor of Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2015-03</date><risdate>2015</risdate><volume>46</volume><issue>3</issue><spage>692</spage><epage>696</epage><pages>692-696</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>BACKGROUND AND PURPOSE—In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion.
METHODS—Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed.
RESULTS—DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001).
CONCLUSION—DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>25649802</pmid><doi>10.1161/STROKEAHA.114.008454</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Angiography Carotid Arteries - pathology Female Fibrinolytic Agents - therapeutic use Humans Infarction, Middle Cerebral Artery - physiopathology Male Middle Aged Retrospective Studies Stroke - drug therapy Thrombolytic Therapy - methods Thrombosis - diagnostic imaging Thrombosis - physiopathology Tomography, X-Ray Computed Treatment Outcome |
| title | Distance to Thrombus in Acute Middle Cerebral Artery Occlusion: A Predictor of Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke |
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