| Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials. | |
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MedLine Citation:
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PMID: 17898199 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Anterior cerebral artery (ACA) emboli may occur before or during fibrinolytic revascularization of middle cerebral artery (MCA) and internal carotid artery (ICA) T occlusions. We sought to determine the incidence and effect of baseline and new embolic ACA occlusions in the Interventional Management of Stroke (IMS) studies. MATERIALS AND METHODS: Case report forms, pretreatment and posttreatment arteriograms, and CTs from 142 subjects entered into IMS I & II were reviewed to identify subjects with baseline ACA occlusion, new ACA emboli occurring during fibrinolysis, subsequent CT-demonstrated infarction in the ACA distribution, and to evaluate global and lower extremity motor clinical outcome. RESULTS: During M1/M2 thrombolysis procedures, new ACA embolus occurred in 1 of 60 (1.7%) subjects. Baseline distal emboli were identified in 3 of 20 (15%) T occlusions before intra-arterial (IA) treatment, and new posttreatment distal ACA emboli were identified in 3 subjects. At 24 hours, 8 (32%) T occlusions demonstrated CT-ACA infarct, typically of small volume. Infarcts were less common following sonography microcatheter-assisted thrombolysis compared with standard microcatheter thrombolysis (P = .05). Lower extremity weakness was present in 9 of 10 subjects with ACA embolus/infarct at 24 hours. The modified Rankin 0 to 2 outcomes were achieved in 4 of 25 (16%) subjects with T occlusion overall, but in 0 of 10 subjects with distal ACA emboli or ACA CT infarcts (P = .07). CONCLUSIONS: With IV/IA recombinant tissue plasminogen activator treatment for MCA emboli, new ACA emboli are uncommon events. Distal ACA emboli during T-occlusion thrombolysis are not uncommon, typically lead to small ACA-distribution infarcts, and may limit neurologic recovery. |
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Authors:
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S King; P Khatri; J Carrozella; J Spilker; J Broderick; M Hill; T Tomsick; |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2007-09-26 |
Journal Detail:
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Title: AJNR. American journal of neuroradiology Volume: 28 ISSN: 0195-6108 ISO Abbreviation: AJNR Am J Neuroradiol Publication Date: 2007 Nov-Dec |
Date Detail:
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Created Date: 2007-11-13 Completed Date: 2008-02-05 Revised Date: 2008-02-14 |
Medline Journal Info:
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Nlm Unique ID: 8003708 Medline TA: AJNR Am J Neuroradiol Country: United States |
Other Details:
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Languages: eng Pagination: 1890-4 Citation Subset: IM |
Affiliation:
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Clinical Coordinating Center, IMS Studies, University of Cincinnati, Cincinnati, OH, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anterior Cerebral Artery* Cerebral Angiography Cerebral Infarction / chemically induced, radiography Clinical Trials as Topic Humans Injections, Intra-Arterial Intracranial Embolism / chemically induced*, radiography Recombinant Proteins / administration & dosage, adverse effects Stroke / drug therapy*, radiography Thrombolytic Therapy / adverse effects* Tissue Plasminogen Activator / administration & dosage*, adverse effects Tomography, X-Ray Computed |
| Grant Support | |
ID/Acronym/Agency:
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NS39160/NS/NINDS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Recombinant Proteins; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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