Large artery occlusion diagnosed by computed tomography angiography in acute ischaemic stroke: Frequency, predictive factors, and safety

Matías‐Guiu, Jordi A.; Serna-Candel, Carmen; Espejo-Domínguez, J.M.; Fernández‐Matarrubia, Marta; Simal, Patricia

doi:10.1016/j.nrleng.2013.06.006

Cited by 3 publications

(3 citation statements)

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“…In another study performed with a similar number of patients, the rate of large vessel occlusion was 52.1% in CTA. However, in that study, patients were evaluated in terms of large vessel occlusion in the first 8 hours and the rate decreased if CTA was performed earlier (14). In both that study and the present study, the M1 segment of the MCA was the most affected artery.…”

Section: Discussionmentioning

confidence: 66%

“…However, it is important not to miss the chance of giving IV rt-PA and according to the current guidelines, physicians should do their best to perform IV rt-PA without losing time (21). Rapid detection of large vessel occlusion is important and CTA in acute stroke is a widely-used reliable and fast modality (14,15,22). Trials searching endovascular approach in acute stroke with intracranial large vessel occlusion include having ≥8 NIHSS scores as a criterion besides non-invasive imaging suggestive of large vessel occlusion because higher NIHSS scores are related with large vessel occlusions (23,24,25,26).…”

Section: Discussionmentioning

confidence: 99%

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Efficiency of Intravenous Thrombolytic Therapy in Isolated Middle Cerebral Artery Occlusions: A Computed Tomography Angiography Study

Eryıldız¹,

Özdemi̇r²

2018

tnd

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Objective:We aimed to evaluate the outcomes of two groups of patients with acute ischemic stroke who were treated with intravenous recombinant tissueplasminogen activator (IV rt-PA); those with isolated middle cerebral artery (MCA) occlusion and those without any large vessel occlusion. Materials and Methods: Data of patients treated with IV rt-PA within 4.5 hours of symptom onset between March 2015 and January 2017 were retrospectively analyzed. Patients were divided into two groups; those with isolated MCA occlusion and those with no large vessel occlusion. Large vessel occlusion was detected with contrast-enhanced computed tomography angiography performed before IV rt-PA. Additionally, demographic and clinical data of the patients were analyzed. The clinical outcomes of the patients were determined using the modified Rankin Scale (mRS) score at 3 months after treatment. Results: A total of 69 patients were included in the study. Isolated MCA occlusion was observed in 28 (40.6%) patients. The rate of very good outcome (mRS 0-1) was 46.4%, whereas the rate of poor outcome (mRS 3-6) was 42.9% in the group with isolated MCA occlusion. Moreover, in the other group, the rate of very good outcome and poor outcome were 65.9% and 26.8%, respectively. Conclusion: In acute ischemic stroke with isolated MCA occlusion, due to the favorable outcomes of the patients, IV rt-PA continues to be the best treatment option in cases where endovascular treatment options cannot be performed and it should be applied by physicians in appropriate cases without delay.Amaç: İntravenöz rekombinant doku-plazminojen aktivatörü (IV rt-PA) uygulanan akut iskemik inme hastalarında izole orta serebral arter (OSA) oklüzyonu olan ve herhangi bir büyük damar oklüzyonu olmayan iki grubun tedavi yanıtlarını ve sonlanımlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: İnme merkezimizde Mart 2015-Ocak 2017 tarihleri arasında semptom sonrası ilk 4,5 saat içerisinde IV rt-PA uygulanan hastaların verileri, izole OSA oklüzyonu olanlar ve herhangi bir büyük damar oklüzyonu olmayanlar olarak ikiye ayrılarak retrospektif olarak analiz edildi. Büyük damar oklüzyonu; IV rt-PA öncesi yapılan kontrastlı bilgisayarlı tomografi anjiyografi ile saptandı. Bunun yanında hastaların demografik ve klinik verileri değerlendirildi. Hastaların klinik sonlanımları ise tedavinin 3. ayında hesaplanan 'the modified Rankin Scale' (mRS) skorları ile belirlendi. Bulgular: Toplam 69 hasta çalışmaya dahil edilmiş olup, bunların 28'inde (%40,6) izole OSA oklüzyonu saptandı. İzole OSA oklüzyonu olan grupta çok iyi sonlanım (mRS 0-1) oranı %46,4 bulunurken, kötü sonlanım (mRS 3-6) oranı %42,9 olarak bulundu. Herhangi bir büyük damar oklüzyonu olmayan grupta ise çok iyi sonlanım oranı %65,9 bulunurken, kötü sonlanım oranı %26,8 olarak bulundu. Sonuç: Akut iskemik inmede izole OSA oklüzyonu varlığında, IV rt-PA; sağladığı iyi sonlanım oranları ile endovasküler tedavi seçeneklerinin uygulanamadığı durumlarda en iyi tedavi seçeneği olmayı sürdürmektedir ve uygun hastalarda klinisyen taraf...

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Efficiency of Intravenous Thrombolytic Therapy in Isolated Middle Cerebral Artery Occlusions: A Computed Tomography Angiography Study

Eryıldız¹,

Özdemi̇r²

2018

tnd

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“…In five large clinical trials investigating the efficacy of EVT, approximately 33% of LVO stroke patients had known AF at the time of presentation [ 8 ]. Similarly, the prevalence of AF is doubled in patients with LVO strokes compared with all other AIS subtypes [ 9 ]. Furthermore, the cause or etiology of nearly half of all LVO cases is cardioembolism, with more than half of cardioembolic cases likely attributed to AF [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Atrial Fibrillation in Large Vessel Occlusion and Large Embolic Stroke of Undetermined Source

Seachrist¹,

Petrone²,

Nevin³

et al. 2023

Cureus

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Introduction: Large vessel occlusion (LVO) stroke is a common presentation of acute ischemic stroke and is often unknown or cryptogenic in etiology. There is a strong association between atrial fibrillation (AF) and cryptogenic LVO stroke, making it a unique stroke subgroup. Therefore, we propose that any LVO stroke meeting the criteria for an embolic stroke of an undetermined source (ESUS) be classified as large ESUS (LESUS). The purpose of this retrospective cohort study was to report the etiology of anterior LVO strokes that underwent endovascular thrombectomy.Methods: This was a single-center retrospective cohort study characterizing the etiology of acute anterior circulation LVO strokes that received emergent endovascular thrombectomy from 2011 to 2018. Patients with LESUS designation at hospital discharge were changed to cardioembolic etiology if AF was discovered during the two-year follow-up period.Results: Overall, 155 (45%) of 307 patients in the study were found to have AF. New onset AF was discovered in 12 (23%) of 53 LESUS patients after hospitalization. Furthermore, eight (35%) of 23 LESUS patients who received extended cardiac monitoring were found to have AF. Conclusion:Nearly half the patients with LVO stroke who received endovascular thrombectomy were found to have AF. With the use of extended cardiac monitoring devices after hospitalization, AF is frequently discovered in patients with LESUS and may change the secondary stroke prevention strategy.

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The collateral circulation determines cortical infarct volume in anterior circulation ischemic stroke

Seyman¹,

Shaim

Shenhar‐Tsarfaty³

et al. 2016

BMC Neurol

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BackgroundAcute ischemic stroke (AIS) is a common neurological event that causes varying degrees of disability. AIS outcome varies considerably, from complete recovery to complete loss of tissue and function. This diversity is partly explained by the compensatory ability of the collateral circulation and the ensuing cerebral flow grade.The collateral flow to the anterior circulation largely supplies the cortical areas. The deep brain tissue is supplied by penetrating arteries and has little or no collateral supply. Although these brain compartments differ substantially in their collateral supply, there are no published data on the different effects the collateral circulation has on them. In addition, the influence of baseline collateral flow on the final infarct size following endovascular or reperfusion therapies remains unknown. This study was designed to determine the effect of the collateral circulation on cortical infarct volume and deep infarct volume, and to investigate the relation between the collateral grade, response to reperfusion therapy and clinical outcome.MethodsWe studied consecutive patients presenting to our medical center between April 2008 and April 2012 with AIS and anterior proximal artery occlusion. To be included patients had to undergo a computerized tomographic angiographic study within 12 h of symptom onset demonstrating the occlusion. Imaging data and clinical and laboratory values were extracted retrospectively from the original scans and medical records. Cortical infarct volume (CIV) and deep infarct volume (DIV) were calculated as well as collateral grade. Clinical outcome was assessed at discharge using the modified Rankin Scale (mRS).ResultsOf the 51 study patients, 13 were treated conservatively, 22 received intravenous recombinant tissue plasminogen activator, and 16 received intra-arterial thrombolysis. The collateral grading was similar for all three treatment groups. While there was a moderate inverse correlation between the collateral grade and CIV (Spearman’s rho = −0.49, P < 0.001), no comparable correlation was observed between the collateral grade and DIV (Spearman’s rho =0.03, P = 0.85). Clinical outcome was significantly related to CIV but not to DIV (Spearman’s rho =0.6 P < 0.001 versus Spearman’s rho =0.09 P = 0.54, respectively). The correlation between the collateral grade and CIV was greatly diminished and lost its statistical significance in patients with successful recanalization (Spearman’s rho = 0.2, p = 0.3).ConclusionsOur data shows that the collateral circulation is an important determinant of cortical infarct volume and, in turn, of clinical outcome in the setting of anterior circulation major artery occlusion. Our findings further demonstrate the benefit of recanalization in sparing cortical tissue from injury. Additional studies are needed to determine the impact of stroke therapy on the final infarct volume in relation to the collateral grade.

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Large artery occlusion diagnosed by computed tomography angiography in acute ischaemic stroke: Frequency, predictive factors, and safety

Cited by 3 publications

References 14 publications

Efficiency of Intravenous Thrombolytic Therapy in Isolated Middle Cerebral Artery Occlusions: A Computed Tomography Angiography Study

Efficiency of Intravenous Thrombolytic Therapy in Isolated Middle Cerebral Artery Occlusions: A Computed Tomography Angiography Study

Incidence of Atrial Fibrillation in Large Vessel Occlusion and Large Embolic Stroke of Undetermined Source

The collateral circulation determines cortical infarct volume in anterior circulation ischemic stroke

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