Lesion patterns in successful and failed thrombolysis in middle cerebral artery stroke
Introduction Thrombolysis has been shown to improve neurological recovery in acute stroke. But the response to thrombolysis is variable across patients. We sought to investigate this variability by analyzing the lesion patterns following systemic thrombolysis with recombinant tissue plasminogen acti...
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| Veröffentlicht in: | Neuroradiology 2009-12, Vol.51 (12), p.865-871 |
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| creator | Seitz, Rüdiger J. Sondermann, Verena Wittsack, Hans-Jörg Siebler, Mario |
| description | Introduction
Thrombolysis has been shown to improve neurological recovery in acute stroke. But the response to thrombolysis is variable across patients. We sought to investigate this variability by analyzing the lesion patterns following systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) and tirofiban in middle cerebral artery (MCA) stroke.
Methods
One hundred three consecutive stroke patients (67 ± 14 years) were grouped according to the site of MCA occlusion and successful or failed recanalization as assessed with magnetic resonance angiography. Infarct lesions were analyzed in T2-weighted magnetic resonance images after 10 days.
Results
Patients recovered markedly upon successful recanalization following thrombolysis (
p
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| doi_str_mv | 10.1007/s00234-009-0576-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_734118308</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1891666811</sourcerecordid><originalsourceid>FETCH-LOGICAL-c431t-45cecbb52935bcb40e6c3d923aa062025b01512137f6f4c89dbc6aaecd917cfb3</originalsourceid><addsrcrecordid>eNp90Utv1DAQB3ALgeh24QNwqSIk4BSY8SOPY1VBQVqJC-3Vsp1JSZvH1pNI3W-Pl121UiU4-TC_mbH9F-IdwmcEKL8wgFQ6B6hzMGWRP7wQK9RK5lhLeClWqVzlqtZwIk6ZbwFAlap8LU6wLpSqlF6J6w1xN43Z1s0zxZGzbsx4CYGY26XP3Nhkret6arL5d5wGP_U77v6qoWuanrJAkXx0icY0YJfxHKc7eiNeta5nens81-Lq29dfF9_zzc_LHxfnmzxohXOuTaDgvZG1Mj54DVQE1dRSOQeFBGk8oEGJqmyLVoeqbnwonKPQ1FiG1qu1-HSYu43T_UI826HjQH3vRpoWtqXSiJWCKsmP_5USparSbyb4_hm8nZY4pldYKRGN3A9cCzygECfmSK3dxm5wcWcR7D4be8jGpmzsPhv7kHrOjoMXP1Dz1HEMI4EPR-A4uL6NbgwdP7q0XRowRXLy4DiVxhuKTzf89_Y_-MynPg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>221152118</pqid></control><display><type>article</type><title>Lesion patterns in successful and failed thrombolysis in middle cerebral artery stroke</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Seitz, Rüdiger J. ; Sondermann, Verena ; Wittsack, Hans-Jörg ; Siebler, Mario</creator><creatorcontrib>Seitz, Rüdiger J. ; Sondermann, Verena ; Wittsack, Hans-Jörg ; Siebler, Mario</creatorcontrib><description>Introduction
Thrombolysis has been shown to improve neurological recovery in acute stroke. But the response to thrombolysis is variable across patients. We sought to investigate this variability by analyzing the lesion patterns following systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) and tirofiban in middle cerebral artery (MCA) stroke.
Methods
One hundred three consecutive stroke patients (67 ± 14 years) were grouped according to the site of MCA occlusion and successful or failed recanalization as assessed with magnetic resonance angiography. Infarct lesions were analyzed in T2-weighted magnetic resonance images after 10 days.
Results
Patients recovered markedly upon successful recanalization following thrombolysis (
p
< 0.05) but remained severely impaired when there was no recanalization within 24 h. Infarct lesions were smaller after successful than after failed recanalization (
p
< 0.005). They occurred throughout the cerebral cortex on the cerebral convexity in distal MCA occlusions with large individual heterogeneity. In contrast, there was a large lesion overlap in insular cortex, basal ganglia, internal capsule, and paraventricular white matter in proximal MCA occlusions.
Conclusion
Systemic thrombolysis with rtPA and tirofiban of MCA occlusions resulted in early neurological recovery and preferentially peri-insular infarcts. In failed recanalization of the MCA stem there was a large lesion overlap in the hemispheric white matter and a lack of recovery.</description><identifier>ISSN: 0028-3940</identifier><identifier>EISSN: 1432-1920</identifier><identifier>DOI: 10.1007/s00234-009-0576-x</identifier><identifier>PMID: 19633834</identifier><identifier>CODEN: NRDYAB</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Aged ; Biological and medical sciences ; Brain damage ; Electrodiagnosis. Electric activity recording ; Female ; Fibrinolytic Agents - therapeutic use ; Functional Neuroradiology ; Humans ; Imaging ; Infarction, Middle Cerebral Artery - diagnosis ; Infarction, Middle Cerebral Artery - therapy ; Investigative techniques, diagnostic techniques (general aspects) ; Magnetic Resonance Angiography - methods ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Middle Cerebral Artery - pathology ; Miscellaneous. Technology ; Nervous system ; Neurology ; Neuroradiology ; Neurosciences ; Neurosurgery ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiology ; Reproducibility of Results ; Sensitivity and Specificity ; Stroke ; Thrombolytic Therapy - methods ; Thrombosis ; Treatment Outcome</subject><ispartof>Neuroradiology, 2009-12, Vol.51 (12), p.865-871</ispartof><rights>Springer-Verlag 2009</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-45cecbb52935bcb40e6c3d923aa062025b01512137f6f4c89dbc6aaecd917cfb3</citedby><cites>FETCH-LOGICAL-c431t-45cecbb52935bcb40e6c3d923aa062025b01512137f6f4c89dbc6aaecd917cfb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00234-009-0576-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00234-009-0576-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22125056$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19633834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Seitz, Rüdiger J.</creatorcontrib><creatorcontrib>Sondermann, Verena</creatorcontrib><creatorcontrib>Wittsack, Hans-Jörg</creatorcontrib><creatorcontrib>Siebler, Mario</creatorcontrib><title>Lesion patterns in successful and failed thrombolysis in middle cerebral artery stroke</title><title>Neuroradiology</title><addtitle>Neuroradiology</addtitle><addtitle>Neuroradiology</addtitle><description>Introduction
Thrombolysis has been shown to improve neurological recovery in acute stroke. But the response to thrombolysis is variable across patients. We sought to investigate this variability by analyzing the lesion patterns following systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) and tirofiban in middle cerebral artery (MCA) stroke.
Methods
One hundred three consecutive stroke patients (67 ± 14 years) were grouped according to the site of MCA occlusion and successful or failed recanalization as assessed with magnetic resonance angiography. Infarct lesions were analyzed in T2-weighted magnetic resonance images after 10 days.
Results
Patients recovered markedly upon successful recanalization following thrombolysis (
p
< 0.05) but remained severely impaired when there was no recanalization within 24 h. Infarct lesions were smaller after successful than after failed recanalization (
p
< 0.005). They occurred throughout the cerebral cortex on the cerebral convexity in distal MCA occlusions with large individual heterogeneity. In contrast, there was a large lesion overlap in insular cortex, basal ganglia, internal capsule, and paraventricular white matter in proximal MCA occlusions.
Conclusion
Systemic thrombolysis with rtPA and tirofiban of MCA occlusions resulted in early neurological recovery and preferentially peri-insular infarcts. In failed recanalization of the MCA stem there was a large lesion overlap in the hemispheric white matter and a lack of recovery.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain damage</subject><subject>Electrodiagnosis. Electric activity recording</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Functional Neuroradiology</subject><subject>Humans</subject><subject>Imaging</subject><subject>Infarction, Middle Cerebral Artery - diagnosis</subject><subject>Infarction, Middle Cerebral Artery - therapy</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery - pathology</subject><subject>Miscellaneous. Technology</subject><subject>Nervous system</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiology</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Stroke</subject><subject>Thrombolytic Therapy - methods</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><issn>0028-3940</issn><issn>1432-1920</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp90Utv1DAQB3ALgeh24QNwqSIk4BSY8SOPY1VBQVqJC-3Vsp1JSZvH1pNI3W-Pl121UiU4-TC_mbH9F-IdwmcEKL8wgFQ6B6hzMGWRP7wQK9RK5lhLeClWqVzlqtZwIk6ZbwFAlap8LU6wLpSqlF6J6w1xN43Z1s0zxZGzbsx4CYGY26XP3Nhkret6arL5d5wGP_U77v6qoWuanrJAkXx0icY0YJfxHKc7eiNeta5nens81-Lq29dfF9_zzc_LHxfnmzxohXOuTaDgvZG1Mj54DVQE1dRSOQeFBGk8oEGJqmyLVoeqbnwonKPQ1FiG1qu1-HSYu43T_UI826HjQH3vRpoWtqXSiJWCKsmP_5USparSbyb4_hm8nZY4pldYKRGN3A9cCzygECfmSK3dxm5wcWcR7D4be8jGpmzsPhv7kHrOjoMXP1Dz1HEMI4EPR-A4uL6NbgwdP7q0XRowRXLy4DiVxhuKTzf89_Y_-MynPg</recordid><startdate>20091201</startdate><enddate>20091201</enddate><creator>Seitz, Rüdiger J.</creator><creator>Sondermann, Verena</creator><creator>Wittsack, Hans-Jörg</creator><creator>Siebler, Mario</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><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>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20091201</creationdate><title>Lesion patterns in successful and failed thrombolysis in middle cerebral artery stroke</title><author>Seitz, Rüdiger J. ; Sondermann, Verena ; Wittsack, Hans-Jörg ; Siebler, Mario</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-45cecbb52935bcb40e6c3d923aa062025b01512137f6f4c89dbc6aaecd917cfb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain damage</topic><topic>Electrodiagnosis. Electric activity recording</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Functional Neuroradiology</topic><topic>Humans</topic><topic>Imaging</topic><topic>Infarction, Middle Cerebral Artery - diagnosis</topic><topic>Infarction, Middle Cerebral Artery - therapy</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery - pathology</topic><topic>Miscellaneous. Technology</topic><topic>Nervous system</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiology</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Stroke</topic><topic>Thrombolytic Therapy - methods</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seitz, Rüdiger J.</creatorcontrib><creatorcontrib>Sondermann, Verena</creatorcontrib><creatorcontrib>Wittsack, Hans-Jörg</creatorcontrib><creatorcontrib>Siebler, Mario</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Neuroradiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Seitz, Rüdiger J.</au><au>Sondermann, Verena</au><au>Wittsack, Hans-Jörg</au><au>Siebler, Mario</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lesion patterns in successful and failed thrombolysis in middle cerebral artery stroke</atitle><jtitle>Neuroradiology</jtitle><stitle>Neuroradiology</stitle><addtitle>Neuroradiology</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>51</volume><issue>12</issue><spage>865</spage><epage>871</epage><pages>865-871</pages><issn>0028-3940</issn><eissn>1432-1920</eissn><coden>NRDYAB</coden><abstract>Introduction
Thrombolysis has been shown to improve neurological recovery in acute stroke. But the response to thrombolysis is variable across patients. We sought to investigate this variability by analyzing the lesion patterns following systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) and tirofiban in middle cerebral artery (MCA) stroke.
Methods
One hundred three consecutive stroke patients (67 ± 14 years) were grouped according to the site of MCA occlusion and successful or failed recanalization as assessed with magnetic resonance angiography. Infarct lesions were analyzed in T2-weighted magnetic resonance images after 10 days.
Results
Patients recovered markedly upon successful recanalization following thrombolysis (
p
< 0.05) but remained severely impaired when there was no recanalization within 24 h. Infarct lesions were smaller after successful than after failed recanalization (
p
< 0.005). They occurred throughout the cerebral cortex on the cerebral convexity in distal MCA occlusions with large individual heterogeneity. In contrast, there was a large lesion overlap in insular cortex, basal ganglia, internal capsule, and paraventricular white matter in proximal MCA occlusions.
Conclusion
Systemic thrombolysis with rtPA and tirofiban of MCA occlusions resulted in early neurological recovery and preferentially peri-insular infarcts. In failed recanalization of the MCA stem there was a large lesion overlap in the hemispheric white matter and a lack of recovery.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>19633834</pmid><doi>10.1007/s00234-009-0576-x</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Biological and medical sciences Brain damage Electrodiagnosis. Electric activity recording Female Fibrinolytic Agents - therapeutic use Functional Neuroradiology Humans Imaging Infarction, Middle Cerebral Artery - diagnosis Infarction, Middle Cerebral Artery - therapy Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Angiography - methods Male Medical sciences Medicine Medicine & Public Health Middle Aged Middle Cerebral Artery - pathology Miscellaneous. Technology Nervous system Neurology Neuroradiology Neurosciences Neurosurgery Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiology Reproducibility of Results Sensitivity and Specificity Stroke Thrombolytic Therapy - methods Thrombosis Treatment Outcome |
| title | Lesion patterns in successful and failed thrombolysis in middle cerebral artery stroke |
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