| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Yeo, Leonard L. L. Kong, Wan Yee Paliwal, Prakash Teoh, Hock L. Seet, Raymond C. Soon, Derek Rathakrishnan, Rahul Ong, Venetia Lee, Tsong-Hai Wong, Ho-Fai Chan, Bernard P. L. Leow, Wee Kheng Yuan, Cheng Ting, Eric Gopinathan, Anil Tan, Benjamin Y. Q. Sharma, Vijay K. |
| Description |
Author Affiliation: Yeo LL ( Division of Neurology, Department of Medicine, National University Health System, Singapore. Electronic address: leonard_ll_yeo@nuhs.edu.sg.); Kong WY ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Paliwal P ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Teoh HL ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Seet RC ( Division of Neurology, Department of Medicine, National University Health System, Singapore); Soon D ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Rathakrishnan R ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Ong V ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Lee TH ( Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan); Wong HF ( College of Medicine and School of Medical Technology, Chang Gung University, Taoyuan, Taiwan); Chan BP ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Leow WK ( Department of Computer Science, National University of Singapore, Singapore.); Yuan C ( Department of Computer Science, National University of Singapore, Singapore.); Ting E ( Department of Diagnostic Imaging, National University Health System, Singapore.); Gopinathan A ( Department of Diagnostic Imaging, National University Health System, Singapore.); Tan BY ( Division of Neurology, Department of Medicine, National University Health System, Singapore.); Sharma VK ( Division of Neurology, Department of Medicine, National University Health System, Singapore) |
| Abstract |
BACKGROUND: Internal carotid artery (ICA) occlusions are poorly responsive to intravenous thrombolysis with tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS). Most study populations have combined intracranial and extracranial ICA occlusions for analysis; few have studied purely cervical ICA occlusions. We evaluated AIS patients with acute cervical ICA occlusion treated with IV-tPA to identify predictors of outcomes. METHODS: We studied 550 consecutive patients with AIS who received IV-tPA and identified 100 with pure acute cervical ICA occlusion. We evaluated the associations of vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and leptomeningeal collateral vessel status via 3 different grading systems, with functional recovery at 90 days, mortality, recanalization of the primary occlusion, and symptomatic intracranial hemorrhage (SICH). Modified Rankin Scale score 0-1 was defined as an excellent outcome. RESULTS: The 100 patients had mean age of 67.8 (range 32-96) and median NIHSS score of 19 (range 4-33). Excellent outcomes were observed in 27% of the patients, SICH in 8%, and mortality in 21%. Up to 54% of the patients achieved recanalization at 24 hours. On ordinal regression, good collaterals showed a significant shift in favorable outcomes by Maas, Tan, or ASPECTS collateral grading systems. On multivariate analysis, good collaterals also showed reduced mortality (OR .721, 95% CI .588-.888, P = .002) and a trend to less SICH (OR .81, 95% CI .65-1.007, P = .058). Interestingly, faster treatment was also associated with favorable functional recovery (OR 1.028 per minute, 95% CI 1.010-1.047, P = .001). CONCLUSIONS: Improved outcomes are seen in patients with early acute cervical ICA occlusion and better collateral circulation. This could be a valuable biomarker for decision making. |
| File Format |
HTM / HTML |
| ISSN |
10523057 |
| Issue Number |
10 |
| Journal |
Journal of Stroke and Cerebrovascular Diseases |
| Volume Number |
25 |
| e-ISSN |
15328511 |
| Language |
English |
| Publisher |
Elsevier |
| Publisher Date |
2016-10-01 |
| Publisher Place |
United States |
| Access Restriction |
One Nation One Subscription (ONOS) |
| Subject Keyword |
Discipline Cardiology |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Rehabilitation Neurology (clinical) Surgery Cardiology and Cardiovascular Medicine |
