BACKGROUND AND PURPOSE: We studied the impact of the location of the thrombus (internal carotid artery, proximal M1 segment, distal M1 segment, M2 segment, and M3 segment of the middle cerebral artery) in predicting the clinical outcome of patients treated with intravenous thrombolytic therapy (<3 h) in a retrospective cohort. METHODS: Anterior circulation thrombus was detected with computed tomography angiography in 105 patients. Baseline clinical and radiological information was collected and entered into logistic regression analysis to predict favorable clinical outcome (3-month modified Rankin Scale from 0 to 2 was a primary outcome measure). RESULTS: Three months after stroke, there was a significant increase in mortality (32% vs. 3%, P < 0.001) and functional dependency (82% vs. 29%, P < 0.001) in patients with internal carotid artery or proximal M1 segment of the middle cerebral artery thrombus compared to a more distal occlusion. In the regression analysis, after adjusting for National Institutes of Health Stroke Scale, age, sex, and onset-to-treatment time, the clot location was an independent predictor of good clinical outcome (P = 0.001) and exhibited dose-response type behavior when moving from a proximal vessel position to a more distal one. When the location was dichotomized, a cutoff between the proximal and the distal M1 segments best differentiated between good and poor clinical outcome (OR = 16.0, 95% CI 3.9-66.2). CONCLUSIONS: The outcome of acute internal carotid artery or proximal M1 segment of the middle cerebral artery occlusion is generally poor even if treated with intravenous thrombolysis. Alternative revascularization strategies should be considered. Vascular imaging at the admission is required to guide this decision.
BACKGROUND AND PURPOSE: We studied the impact of the location of the thrombus (internal carotid artery, proximal M1 segment, distal M1 segment, M2 segment, and M3 segment of the middle cerebral artery) in predicting the clinical outcome of patients treated with intravenous thrombolytic therapy (<3 h) in a retrospective cohort. METHODS: Anterior circulation thrombus was detected with computed tomography angiography in 105 patients. Baseline clinical and radiological information was collected and entered into logistic regression analysis to predict favorable clinical outcome (3-month modified Rankin Scale from 0 to 2 was a primary outcome measure). RESULTS: Three months after stroke, there was a significant increase in mortality (32% vs. 3%, P < 0.001) and functional dependency (82% vs. 29%, P < 0.001) in patients with internal carotid artery or proximal M1 segment of the middle cerebral artery thrombus compared to a more distal occlusion. In the regression analysis, after adjusting for National Institutes of Health Stroke Scale, age, sex, and onset-to-treatment time, the clot location was an independent predictor of good clinical outcome (P = 0.001) and exhibited dose-response type behavior when moving from a proximal vessel position to a more distal one. When the location was dichotomized, a cutoff between the proximal and the distal M1 segments best differentiated between good and poor clinical outcome (OR = 16.0, 95% CI 3.9-66.2). CONCLUSIONS: The outcome of acute internal carotid artery or proximal M1 segment of the middle cerebral artery occlusion is generally poor even if treated with intravenous thrombolysis. Alternative revascularization strategies should be considered. Vascular imaging at the admission is required to guide this decision.
Authors: Guillaume Bouchoux; Ravishankar Shivashankar; Todd A Abruzzo; Christy K Holland Journal: Ultrasound Med Biol Date: 2014-03-14 Impact factor: 2.998
Authors: A M J Frölich; D Schrader; E Klotz; R Schramm; K Wasser; M Knauth; P Schramm Journal: AJNR Am J Neuroradiol Date: 2013-04-25 Impact factor: 3.825
Authors: S M Mishra; J Dykeman; T T Sajobi; A Trivedi; M Almekhlafi; S I Sohn; S Bal; E Qazi; A Calleja; M Eesa; M Goyal; A M Demchuk; B K Menon Journal: AJNR Am J Neuroradiol Date: 2014-07-24 Impact factor: 3.825
Authors: Andrew M Demchuk; Mayank Goyal; Sharon D Yeatts; Janice Carrozzella; Lydia D Foster; Emmad Qazi; Michael D Hill; Tudor G Jovin; Marc Ribo; Bernard Yan; Osama O Zaidat; Donald Frei; Rüdiger von Kummer; Kevin M Cockroft; Pooja Khatri; David S Liebeskind; Thomas A Tomsick; Yuko Y Palesch; Joseph P Broderick Journal: Radiology Date: 2014-06-05 Impact factor: 11.105
Authors: Mark J R J Bouts; Ivo A C W Tiebosch; Annette van der Toorn; Jeroen Hendrikse; Rick M Dijkhuizen Journal: J Cereb Blood Flow Metab Date: 2013-12-04 Impact factor: 6.200
Authors: Niko Sillanpää; Sara Protto; Jukka T Saarinen; Juha-Pekka Pienimäki; Janne Seppänen; Heikki Numminen; Harri Rusanen Journal: Interv Neurol Date: 2017-05-19