| Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment. | |
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MedLine Citation:
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PMID: 15709120 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: The relationship between location of occlusion and clinical outcome is poorly understood in patients receiving intravenous tissue-type plasminogen activator (IV tPA). We postulated that acute stroke patients receiving IV tPA with patent vasculature or occult arterial occlusion by CT angiography (CTA) would have better outcomes and decreased hemorrhagic risk. METHODS: We identified 47 patients from our prospective stroke database who underwent CTA before treatment with IV tPA. Site of occlusion was categorized as M1 segment of the middle cerebral artery, M2 segment, multiple (either carotid, basilar, or both middle and anterior cerebral arteries), or absent (no occlusion proximal to M3). The effect of site of occlusion on National Institutes of Health Stroke Scale (NIHSS), early improvement (> or = 4-point improvement in NIHSS at 24 hours after treatment), intracranial hemorrhages, and modified Rankin scale (mRS) at 7 days was tested in a multivariate analysis. RESULTS: The location of occlusion correlated with initial NIHSS for multiple, M1, M2 and absent occlusions (median NIHSS scores were 18, 18, 15, 10, respectively) (P < .02, rank sum). Following adjustment for initial NIHSS, age, and time to treatment, the absence of occlusion remained associated with early improvement (OR 5.0, 95% CI 1.1-23.3; P = .04) and independence at day 7 (mRS < or = 2) (OR 6.8, 95% CI 1.3-34.6; P = .02). Overall prevalence of symptomatic hemorrhages was 6.4%. Patients without occlusion had no hemorrhages (0% versus 23.3%; P < .04). CONCLUSION: Among patients treated with tPA, those with patent vasculature or occult distal occlusion on CTA before treatment have lower NIHSS, better chances of early improvement and early independence with fewer hemorrhages. |
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Authors:
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John R Sims; Guy Rordorf; Eric E Smith; Walter J Koroshetz; Michael H Lev; Ferdinando Buonanno; Lee H Schwamm |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: AJNR. American journal of neuroradiology Volume: 26 ISSN: 0195-6108 ISO Abbreviation: AJNR Am J Neuroradiol Publication Date: 2005 Feb |
Date Detail:
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Created Date: 2005-02-14 Completed Date: 2005-12-22 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: 246-51 Citation Subset: IM |
Affiliation:
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Department of Neurology, Massachusetts General Hospital, CNY 149, Room 6403, Charlestown, MA 02129, USA. jsims@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angiography / methods* Female Fibrinolytic Agents / administration & dosage* Humans Injections, Intravenous Intracranial Arteriosclerosis / complications, drug therapy*, radiography* Male Prospective Studies Severity of Illness Index Stroke / drug therapy*, etiology, radiography* Tomography, X-Ray Computed* |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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