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Length of occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke
V. Rohan, J. Baxa, R. Tupy, L. Cerna, P. Sevcik, M. Friesl, J. Polivka, J. Polivka, J. Ferda,
Language English Country United States
Document type Journal Article, Research Support, Non-U.S. Gov't
NLK
Free Medical Journals
from 1970 to 1 year ago
Open Access Digital Library
from 1970-01-01
Open Access Digital Library
from 1970-01-01
- MeSH
- Four-Dimensional Computed Tomography instrumentation methods MeSH
- Adult MeSH
- Fibrinolytic Agents administration & dosage pharmacology MeSH
- Infarction, Middle Cerebral Artery * drug therapy pathology radiography MeSH
- Middle Aged MeSH
- Humans MeSH
- Cerebral Angiography MeSH
- Cerebrovascular Circulation drug effects physiology MeSH
- Predictive Value of Tests MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Tissue Plasminogen Activator administration & dosage pharmacology MeSH
- Thrombolytic Therapy methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND AND PURPOSE: The length of large vessel occlusion is considered a major factor for therapy in patients with ischemic stroke. We used 4D-CT angiography evaluation of middle cerebral artery occlusion in prediction of recanalization and favorable clinical outcome and after intravenous thrombolysis (IV-tPA). METHODS: In 80 patients treated with IV-tPA for acute complete middle cerebral artery/M1 occlusion determined using CT angiography and temporal maximum intensity projection, calculated from 4D-CT angiography, the length of middle cerebral artery proximal stump, occlusion in M1 or M1 and M2 segment were measured. Univariate and multivariate analyses were performed to define independent predictors of successful recanalization after 24 hours and favorable outcome after 3 months. RESULTS: The length of occlusion was measureable in all patients using temporal maximum intensity projection. Recanalization thrombolysis in myocardial infarction 2 to 3 was achieved in 37 individuals (46%). The extension to M2 segment as a category (odds ratio, 4.58; 95% confidence interval, 1.39-15.05; P=0.012) and the length of M1 segment occlusion (odds ratio, 0.82; 95% confidence interval, 0.73-0.92; P=0.0007) with an optimal cutoff value of 12 mm (sensitivity 0.67; specificity 0.71) were significant independent predictors of recanalization. Favorable outcome (modified Rankin scale 0-2) was achieved in 25 patients (31%), baseline National Institutes of Health Stroke Scale (odds ratio, 0.82; 95% confidence interval, 0.72-0.93; P=0.003) and the length of occlusion M1 in segment (odds ratio, 0.79; 95% confidence interval, 0.69-0.91; P=0.0008) with an optimal cutoff value of 11 mm (sensitivity 0.74; specificity 0.76) were significant independent predictors of favorable outcome. CONCLUSIONS: The length of middle cerebral artery occlusion is an independent predictor of successful IV-tPA treatment.
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- $a Rohan, Vladimir $u From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.). rohan@fnplzen.cz.
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- $a Length of occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke / $c V. Rohan, J. Baxa, R. Tupy, L. Cerna, P. Sevcik, M. Friesl, J. Polivka, J. Polivka, J. Ferda,
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- $a BACKGROUND AND PURPOSE: The length of large vessel occlusion is considered a major factor for therapy in patients with ischemic stroke. We used 4D-CT angiography evaluation of middle cerebral artery occlusion in prediction of recanalization and favorable clinical outcome and after intravenous thrombolysis (IV-tPA). METHODS: In 80 patients treated with IV-tPA for acute complete middle cerebral artery/M1 occlusion determined using CT angiography and temporal maximum intensity projection, calculated from 4D-CT angiography, the length of middle cerebral artery proximal stump, occlusion in M1 or M1 and M2 segment were measured. Univariate and multivariate analyses were performed to define independent predictors of successful recanalization after 24 hours and favorable outcome after 3 months. RESULTS: The length of occlusion was measureable in all patients using temporal maximum intensity projection. Recanalization thrombolysis in myocardial infarction 2 to 3 was achieved in 37 individuals (46%). The extension to M2 segment as a category (odds ratio, 4.58; 95% confidence interval, 1.39-15.05; P=0.012) and the length of M1 segment occlusion (odds ratio, 0.82; 95% confidence interval, 0.73-0.92; P=0.0007) with an optimal cutoff value of 12 mm (sensitivity 0.67; specificity 0.71) were significant independent predictors of recanalization. Favorable outcome (modified Rankin scale 0-2) was achieved in 25 patients (31%), baseline National Institutes of Health Stroke Scale (odds ratio, 0.82; 95% confidence interval, 0.72-0.93; P=0.003) and the length of occlusion M1 in segment (odds ratio, 0.79; 95% confidence interval, 0.69-0.91; P=0.0008) with an optimal cutoff value of 11 mm (sensitivity 0.74; specificity 0.76) were significant independent predictors of favorable outcome. CONCLUSIONS: The length of middle cerebral artery occlusion is an independent predictor of successful IV-tPA treatment.
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- $a Tupy, Radek $u From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
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