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Intravenous thrombolysis outcomes in patients presenting with large vessel acute ischemic strokes--CT angiography-based prognosis.
J Neuroimaging. 2015 Mar-Apr; 25(2):238-242.JN

Abstract

BACKGROUND AND PURPOSE

To establish outcome rates for patients receiving intravenous thrombolysis based on vascular occlusion site.

METHODS

This is a retrospective analysis of 225 patients who had received intravenous-rt-PA for anterior circulation strokes. The occlusion-site was prospectively determined on the admission computed tomographic angiography (CTA) and divided into: large vessel occlusion (LVO) including patients with an internal carotid artery terminus or middle cerebral artery (M1/proximal M2) occlusions and no large vessel occlusion (No-LVO; distal M2/M3/ACA) including patients with either distal or no occlusions. The primary outcome was the modified Rankin score (mRS) at 90-days with a good outcome defined by mRS of 0-2.000.

RESULTS

There were 114 (50.7%) patients in the LVO and 111 (49.3%) in the No-LVO group. A good outcome was seen in 28 (24.6%) patients in the LVO and 77 (69.4%) patients in the No-LVO group (OR .14; 95% CI: .08-.26; P < .0001). Mortality was observed in 13 (11.7%) patients in the No-LVO group and 48 (42.1%) patients in the LVO group (OR .18; 95% CI: .09-.36; P < .0001). Significant hemorrhage was seen in 14 (12.5%) patients in the LVO and 0 (0%) patients in the No-LVO group (P < .0001). Older age (OR .96; 95% CI: .93-.98; P = .002) and presence of LVO (OR .29; 95% CI: .12-.68; P = .004) were significant independent predictors of poor outcome.

CONCLUSION

CTA identification of proximal occlusions is associated with significantly poor outcomes in patients receiving intravenous stroke thrombolysis.

Authors+Show Affiliations

Radiology & Neurology, West Virginia University, Morgantown, WV.Neuroradiology, West Virginia University, Morgantown, WV.Neuroradiology, West Virginia University, Morgantown, WV.Neuroradiology, West Virginia University, Morgantown, WV.Neuroradiology, West Virginia University, Morgantown, WV.

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

24888428

Citation

Rai, Ansaar, et al. "Intravenous Thrombolysis Outcomes in Patients Presenting With Large Vessel Acute Ischemic strokes--CT Angiography-based Prognosis." Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging, vol. 25, no. 2, 2015, pp. 238-242.
Rai A, Cline B, Williams E, et al. Intravenous thrombolysis outcomes in patients presenting with large vessel acute ischemic strokes--CT angiography-based prognosis. J Neuroimaging. 2015;25(2):238-242.
Rai, A., Cline, B., Williams, E., Carpenter, J., & Roberts, T. (2015). Intravenous thrombolysis outcomes in patients presenting with large vessel acute ischemic strokes--CT angiography-based prognosis. Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging, 25(2), 238-242. https://doi.org/10.1111/jon.12126
Rai A, et al. Intravenous Thrombolysis Outcomes in Patients Presenting With Large Vessel Acute Ischemic strokes--CT Angiography-based Prognosis. J Neuroimaging. 2015 Mar-Apr;25(2):238-242. PubMed PMID: 24888428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous thrombolysis outcomes in patients presenting with large vessel acute ischemic strokes--CT angiography-based prognosis. AU - Rai,Ansaar, AU - Cline,Brendan, AU - Williams,Eric, AU - Carpenter,Jeffrey, AU - Roberts,Thomas, Y1 - 2014/06/03/ PY - 2013/10/17/received PY - 2014/01/29/revised PY - 2014/03/02/accepted PY - 2014/6/4/entrez PY - 2014/6/4/pubmed PY - 2016/4/8/medline KW - CTA KW - Stroke KW - thrombolysis SP - 238 EP - 242 JF - Journal of neuroimaging : official journal of the American Society of Neuroimaging JO - J Neuroimaging VL - 25 IS - 2 N2 - BACKGROUND AND PURPOSE: To establish outcome rates for patients receiving intravenous thrombolysis based on vascular occlusion site. METHODS: This is a retrospective analysis of 225 patients who had received intravenous-rt-PA for anterior circulation strokes. The occlusion-site was prospectively determined on the admission computed tomographic angiography (CTA) and divided into: large vessel occlusion (LVO) including patients with an internal carotid artery terminus or middle cerebral artery (M1/proximal M2) occlusions and no large vessel occlusion (No-LVO; distal M2/M3/ACA) including patients with either distal or no occlusions. The primary outcome was the modified Rankin score (mRS) at 90-days with a good outcome defined by mRS of 0-2.000. RESULTS: There were 114 (50.7%) patients in the LVO and 111 (49.3%) in the No-LVO group. A good outcome was seen in 28 (24.6%) patients in the LVO and 77 (69.4%) patients in the No-LVO group (OR .14; 95% CI: .08-.26; P < .0001). Mortality was observed in 13 (11.7%) patients in the No-LVO group and 48 (42.1%) patients in the LVO group (OR .18; 95% CI: .09-.36; P < .0001). Significant hemorrhage was seen in 14 (12.5%) patients in the LVO and 0 (0%) patients in the No-LVO group (P < .0001). Older age (OR .96; 95% CI: .93-.98; P = .002) and presence of LVO (OR .29; 95% CI: .12-.68; P = .004) were significant independent predictors of poor outcome. CONCLUSION: CTA identification of proximal occlusions is associated with significantly poor outcomes in patients receiving intravenous stroke thrombolysis. SN - 1552-6569 UR - https://www.unboundmedicine.com/medline/citation/24888428/Intravenous_thrombolysis_outcomes_in_patients_presenting_with_large_vessel_acute_ischemic_strokes__CT_angiography_based_prognosis_ L2 - https://doi.org/10.1111/jon.12126 DB - PRIME DP - Unbound Medicine ER -