Document Detail

Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials.
MedLine Citation:
PMID:  17898199     Owner:  NLM     Status:  MEDLINE    
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.
S King; P Khatri; J Carrozella; J Spilker; J Broderick; M Hill; T Tomsick;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-09-26
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  28     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:    2007 Nov-Dec
Date Detail:
Created Date:  2007-11-13     Completed Date:  2008-02-05     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1890-4     Citation Subset:  IM    
Clinical Coordinating Center, IMS Studies, University of Cincinnati, Cincinnati, OH, USA.
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MeSH Terms
Anterior Cerebral Artery*
Cerebral Angiography
Cerebral Infarction / chemically induced,  radiography
Clinical Trials as Topic
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
Reg. No./Substance:
0/Recombinant Proteins; EC Plasminogen Activator

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