Infarct Core Expansion on Computed Tomography before and after Intravenous Thrombolysis.
10.3349/ymj.2018.59.2.310
- Author:
Dongbeom SONG
1
;
Joonsang YOO
;
Jang Hyun BAEK
;
Jinkwon KIM
;
Hye Sun LEE
;
Young Dae KIM
;
Hyo Suk NAM
;
Ji Hoe HEO
Author Information
1. Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. jhheo@yuhs.ac
- Publication Type:Original Article
- Keywords:
Acute stroke therapy;
ischemic stroke;
CT scan;
collateral circulation;
tissue plasminogen activator
- MeSH:
Administration, Intravenous;
Aged;
Brain Infarction/*diagnostic imaging/*therapy;
Computed Tomography Angiography;
Female;
Fibrinolytic Agents/therapeutic use;
Follow-Up Studies;
Humans;
Male;
*Thrombolytic Therapy;
Tomography, X-Ray Computed/*methods;
Treatment Outcome
- From:Yonsei Medical Journal
2018;59(2):310-316
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Infarct core can expand rapidly in acute stroke patients receiving intravenous tissue plasminogen activator (IV t-PA). We investigated changes in the extent of infarct core during IV t-PA treatment, and explored the associative factors of this infarct core expansion in patients with proximal artery occlusion. MATERIALS AND METHODS: We included patients who were considered for sequential intra-arterial therapy (IAT) due to occlusion of intracranial proximal artery after IV t-PA. Patients who had a baseline Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) ≥6 and who underwent two consecutive CT scans before and shortly after IV t-PA infusion were enrolled. Patients were classified into no, moderate, and marked expansion groups based on decreases in ASPECTS (0–1, 2–3, and ≥4, respectively) on follow-up CT. Collateral status was graded using CT angiography. RESULTS: Of the 104 patients, 16 (15.4%) patients showed moderate and 13 (12.5%) patients showed marked infarct core expansion on follow-up CT scans obtained at 71.1±19.1 min after baseline CT scan. Sixteen (15.4%) patients had an ASPECTS value < 6 on the follow-up CT. None of the patients with marked expansion were independent at 3 months. Univariate analysis and ordinal logistic regression analysis demonstrated that the infarct core expansion was significantly associated with collateral status (p < 0.001). CONCLUSION: Among patients who were considered for IAT after IV t-PA treatment, one out of every seven patients exhibited marked expansion of infarct core on follow-up CT before IAT. These patients tend to have poor collaterals and poor outcomes despite rescue IAT.
