Pierre Seners1, Robert Hurford1, Marie Tisserand1, Guillaume Turc1, Laurence Legrand1, Olivier Naggara1, Jean-Louis Mas1, Catherine Oppenheim1, Jean-Claude Baron2. 1. From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.). 2. From the Departments of Neurology (P.S., G.T., J.-L.M., J.-C.B.) and Radiology (L.L., O.N., C.O.), Hôpital Sainte-Anne, Paris, France; Université Paris Descartes, Sorbonne Paris Citeé, INSERM UMR S894, DHU Neurovasc, France (P.S., G.T., L.L., O.N., J.-L.M., C.O., J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, United Kingdom (R.H.); and Service de Radiologie, Hoôpital Foch, Suresnes, France (M.T.). jean-claude.baron@inserm.fr.
Abstract
BACKGROUND AND PURPOSE: Early neurological deterioration (END) after anterior circulation stroke is strongly associated with poor outcome. Apart from straightforward causes, such as intracerebral hemorrhage and malignant edema, the mechanism of END occurring after intravenous thrombolysis remains unclear in most instances. We tested the hypothesis that unexplained END is associated with thrombus extension. METHODS: From our database of consecutively thrombolysed patients, we identified anterior circulation stroke patients who had both admission and 24-hour T2* magnetic resonance imaging, visible occlusion on admission magnetic resonance angiography and no recanalization on 24-hour magnetic resonance angiography. END was defined as ≥4 National Institutes of Health Stroke Scale-point deterioration on 24-hour clinical assessment and unexplained END as END without clear cause. The incidence of susceptibility vessel sign extension on T2* imaging, defined as any new occurrence or extension of susceptibility vessel sign from admission to 24-hour follow-up magnetic resonance, was compared between patients with unexplained END and those without END. RESULTS: Of 120 eligible patients for the present study, 22 experienced unexplained END. Susceptibility vessel sign extension was present in 41 (34%) patients and was significantly more frequent in the unexplained END than in the no-END group (59% versus 29%, respectively; adjusted odds ratio=3.96; 95% confidence interval, 1.25-12.53; P=0.02). CONCLUSIONS: In this study, unexplained END occurring after thrombolysis was independently associated with susceptibility vessel sign extension, suggesting in situ thrombus extension or re-embolization. These findings strengthen the need to further investigate early post-thrombolysis administration of antithrombotics to reduce the risk of this ominous clinical event.
BACKGROUND AND PURPOSE: Early neurological deterioration (END) after anterior circulation stroke is strongly associated with poor outcome. Apart from straightforward causes, such as intracerebral hemorrhage and malignant edema, the mechanism of END occurring after intravenous thrombolysis remains unclear in most instances. We tested the hypothesis that unexplained END is associated with thrombus extension. METHODS: From our database of consecutively thrombolysed patients, we identified anterior circulation strokepatients who had both admission and 24-hour T2* magnetic resonance imaging, visible occlusion on admission magnetic resonance angiography and no recanalization on 24-hour magnetic resonance angiography. END was defined as ≥4 National Institutes of Health Stroke Scale-point deterioration on 24-hour clinical assessment and unexplained END as END without clear cause. The incidence of susceptibility vessel sign extension on T2* imaging, defined as any new occurrence or extension of susceptibility vessel sign from admission to 24-hour follow-up magnetic resonance, was compared between patients with unexplained END and those without END. RESULTS: Of 120 eligible patients for the present study, 22 experienced unexplained END. Susceptibility vessel sign extension was present in 41 (34%) patients and was significantly more frequent in the unexplained END than in the no-END group (59% versus 29%, respectively; adjusted odds ratio=3.96; 95% confidence interval, 1.25-12.53; P=0.02). CONCLUSIONS: In this study, unexplained END occurring after thrombolysis was independently associated with susceptibility vessel sign extension, suggesting in situ thrombus extension or re-embolization. These findings strengthen the need to further investigate early post-thrombolysis administration of antithrombotics to reduce the risk of this ominous clinical event.
Authors: Michael V Mazya; Charith Cooray; Kennedy R Lees; Danilo Toni; Gary A Ford; Michal Bar; Senta Frol; Tiago Moreira; Lakshmanan Sekaran; Viktor Švigelj; Nils Wahlgren; Niaz Ahmed Journal: Eur Stroke J Date: 2017-11-29
Authors: Jose G Romano; Hannah Gardener; Iszet Campo-Bustillo; Yosef Khan; Sofie Tai; Nikesha Riley; Eric E Smith; Ralph L Sacco; Pooja Khatri; Heather M Alger; Brian Mac Grory; Deepak Gulati; Navdeep S Sangha; Jeffrey M Craig; Karin E Olds; Curtis G Benesch; Adam G Kelly; Scott S Brehaut; Amit C Kansara; Lee H Schwamm Journal: Stroke Date: 2021-05-05 Impact factor: 10.170
Authors: Heitor C Alves; Kilian M Treurniet; Ivo G H Jansen; Albert J Yoo; Bruna G Dutra; Guang Zhang; Lonneke Yo; Adriaan C G M van Es; Bart J Emmer; René van den Berg; Ido R van den Wijngaard; Geert J Lycklama À Nijeholt; Jan-Albert Vos; Yvo B W E M Roos; Wouter Schonewille; Henk A Marquering; Charles B L M Majoie Journal: Stroke Date: 2019-10-10 Impact factor: 7.914