EVALUATION OF EARLY ISCHEMIC CHANGES IN STROKE PATIENTS TREATED WITH THROMBOLYTIC THERAPY
Introduction:The aim of this study is to evaluate early brain ischemic changes on CT scan in stroke patients in correlation with the clinical outcome, as well as to evaluate if there is prognostic and predictive features that can be used. Patients and methods: We examined 20 patients with acute ischemic stroke, from which 12 were male and 8 were female, at the age from 47 to 76 years. Results: The hyperdense medial artery (HMA) sign was present in 10 (50%) patients. Concerning the ASPECTS score, 5 patients (25%) had normal score of 10 points, while 7 patients (35%) had score of 7 points. 12 patients (60%) had unfavorable outcome, while 8 patients (40%) had favorable outcome. Our statistical analysis shows that age of more than 65 years, presence of 2 or more risk-factors, ASPECTS score of 7 and presence of HMA sign were all statistically significant predictors of unfavorable outcome in examined patients (p<0.05 each). The presence of the hyperdense medial artery sign was the most significant single predictor for unfavorable clinical outcome (p=0.0042, p<0.05).
Conclusion:The presence of HMA sign is the most significant single predictor for unfavorable clinical outcome.
Ropper A H, Brown R H. Adams and Victor's Principles of Neurology .8th Edition. New York: McGraw-Hill Professional-medical publishing division, USA, 2005.
MacKay J, Mensah GA. World Health Organization. Global Burden of Stroke. The Atlas of Heart Disease and Stroke. Available at http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf.
Wintermark M, Sanelli PC, Albers GW, et al. Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. Am J Neuroradiol. 2013;34(11): E117-27.
von Kummer R, Meyding-Lamadu U, Forsting M, et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. Am J Neuroradiol. 1994; 15(1): 9–15.
Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355(9216):1670-4.
Dzialowski I, Hill MD, Coutts SB, et al. Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II. Stroke. 2006;37(4):973–8.
Mak HK, Yau KK, Khong PL, et al. Hypodensity of >1/3 middle cerebral artery territory versus Alberta Stroke Programme Early CT Score (ASPECTS): comparison of two methods of quantitative evaluation of early CT changes in hyperacute ischemic stroke in the community setting. Stroke. 2003; 34(5):1194-6.
Pexman JH, Barber PA, Hill MD, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. Am J Neuroradiol. 2001;22(8):1534-42.
Weir NU, Pexman JH, Hill MD, Buchan AM, CASES investigators. How well does ASPECTS predict the outcome of acute stroke treated with IV tPA? Neurology. 2006;67(3):516–8.
Rutgers DR, van der Grond J, Jansen GH, Somford DM, Mali WP. Radiologic-pathologic correlation of the hyperdense middle cerebral artery sign. A case report. Acta Radiol.2001;42(5):467–9.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359(13):1317–29.
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995; 333(24):1581–7.
Kim JT, Park MS,Nam TS, et al. Thrombolysis as a factor associated with favorable outcomes in patients with unclear-onset stroke. Eur J Neurol. 2011; 18(7):988–94.
Quinn TJ, Dawson J, Walters M. Dr. John Rankin; his life, legacy and the 50th anniversary of the Rankin stroke scale. Scott Med J. 2008; 53(1):44–7.
Brown DL, Johnston KC, Wagner DP, Haley EC Jr. Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke. Stroke. 2004;35(1):147–50.
Saposnik G, Di Legge S, Webster F, Hachinski V. Predictors of major neurologic improvement after thrombolysis in acute stroke. Neurology. 2005;65(8):1169–74.
Heiss WD. The ischemic penumbra: correlates in imaging and implications for treatment of ischemic stroke. Cerebrovasc Dis. 2011; 32(4):307–20.
Hill MD, Demchuk AM, Tomsick TA, Palesch YY, Broderick JP. Using the baseline CT scan to select acute stroke patients for IV-IA therapy. Am J Neuroradiol. 2006;27(8):1612–6.
Johnston KC, Connors AF Jr, Wagner DP, Knaus WA, Wang X, Haley EC Jr: A predictive risk model for outcomes of ischemic stroke. Stroke. 2000; 31(2): 448–55.
Konig IR, Ziegler A, Bluhmki E, et al. Predicting long-term outcome after acute ischemic stroke: a simple index works in patients from controlled clinical trials. Stroke. 2008; 39(6): 1821–6.
Reid JM, Gubitz GJ, Dai D, et al. Predicting functional outcome after stroke by modelling baseline clinical and CT variables. Age Ageing. 2010; 39(3): 360–6.
Milosavljevi? T, Ivkovi? A. Rescuing the ischemic penumbra: Our experience. Sanamed. 2013; 8(2):123-30.
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