Brain Imaging Findings and Response to Intravenous Thrombolysis in Posterior Circulation Stroke
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ORIGINAL RESEARCH
Brain Imaging Findings and Response to Intravenous Thrombolysis in Posterior Circulation Stroke ˇ a´k Toma´ˇs Dorn
. Zuzana Sedla´cˇkova´ . Jakub C ˇ ivrny´ .
ˇ a´k . Michal Kra´l . Petra Divisˇova´ . Petr Polidar . Daniel Sˇan ˇ ovsky´ Jana Zapletalova´ . Petr Kan
Received: August 4, 2020 / Accepted: October 21, 2020 Ó Springer Healthcare Ltd., part of Springer Nature 2020
ABSTRACT Introduction: Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischaemic stroke (ACIS) and posterior circulation ischaemic stroke (PCIS). Our aim was to evaluate the predictors for a good clinical outcome and intracerebral haemorrhage (ICH) in patients undergoing posterior circulation IVT based on the initially performed CT or MR imaging. Methods: The study cohort consisted of 1643 consecutive patients with acute ischaemic stroke (1440 ACIS, 203 PCIS cases) who underwent IVT. ICH was classified according to the
ˇ a´k (&) M. Kra´l P. Divisˇova´ P. Polidar T. Dorn ˇ a´k P. Kan ˇ ovsky´ D. Sˇan Comprehensive Stroke Center, Department of Neurology, Palacky´ University and University Hospital, Olomouc, Czech Republic e-mail: [email protected] ˇ ivrny´ Z. Sedla´cˇkova´ J. C Comprehensive Stroke Center, Department of Radiology, Palacky´ University and University Hospital, Olomouc, Czech Republic J. Zapletalova´ Department of Medical Biophysics, Palacky´ University, Olomouc, Czech Republic
European Cooperative Acute Stroke Study (ECASS) I protocol. Clinical outcome was assessed using the modified Rankin scale (mRS). Early ischaemic signs and pre-existing structural signs were assessed. Results: Good clinical outcomes (mRS 0–1) were noted in 45.3% of patients with PCIS, with a mortality rate of 14.8%. ICH was noted in 8.3%, and a large haemorrhage was found in 2.4% of patients. Some early ischaemic signs and pre-existing structural signs on initial CT/ MR imaging correlated significantly with the 90-day clinical outcome. Conclusions: Early ischaemic signs and pre-existing structural signs should be considered during the assessment of patients with PCIS eligible for IVT. Tissue hypoattenuation on initial CT scans correlates with an increased risk of death. Similarly to anterior circulation, atrophy on initial MRI may negatively predict good clinical outcome in posterior circulation. Keywords: Alteplase; Imaging; Posterior circulation; Ischaemic stroke; Thrombolysis
Adv Ther
Key Summary Points Why carry out this study? The overall benefit of recombinant tissue plasminogen activator is believed to outweigh the increased risk for symptomatic intracranial haemorrhage and death. There are situations where the benefit is equal to or greater than the risk, such as when patients are relatively indicated/contraindicated because the class (strength) of recommendation is Class IIb or III according to the most recent American Heart Association/ American Stroke Association (AHA/ASA) recommendations from 2018 Pre-existing signs such as leukoaraiosis, cerebral atrophy and old infarc
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