(Stroke. 1995;26:581-587.)
© 1995 American Heart Association, Inc.
Articles |
Does Arterial Recanalization Improve Outcome in Carotid Territory Stroke?
From the Departments of Neuroradiology (R. von K., M.F.), Medical Biometry (R.H.), and Neurology (L.R., W.H.), University of Heidelberg School of Medicine (Germany).
Background and Purpose We sought to determine whether early (<8 hours) or delayed (8 to 24 hours) recanalization after stroke may be an independent variable in the improvement of clinical outcome in patients with occlusion of the middle cerebral artery.
Methods We prospectively studied 77 patients by combined Scandinavian Stroke Scale score at admission, repeated computed tomography and angiography before and after thrombolytic treatment at <8 hours after stroke onset, and transcranial Doppler ultrasound 24 hours later. We tested an association between clinical and neuroradiological baseline characteristics, recanalization, and outcome as assessed by the modified Rankin Scale 4 weeks after stroke and determined the effect of recanalization on mortality and good outcome (Rankin Scale grades 0 to 3) by multiple logistic regression analyses.
Results Recanalization rates at 8 and 24 hours after stroke correlated with sites of occlusion (middle cerebral artery branch, 73% and 73%; trunk, 27% and 38%, respectively; intracranial internal carotid artery bifurcation, 14% and 14%; P=.002), collaterals (good, 43% and 51%, respectively; scarce, 17% and 19%, respectively; P=.01), and Scandinavian Stroke Scale score at admission (P=.002). Six of 7 patients with delayed recanalization had good outcomes. Recanalization at <8 hours after symptom onset had no independent predictive value for good outcome (P=.69). Recanalization at 24 hours increased the proportion of good outcomes from 23% to 75% in a subgroup of patients. Recanalization did not independently affect mortality (P>.15).
Conclusions Even if delayed, arterial recanalization may improve clinical outcome in a subgroup of patients with middle cerebral artery occlusion.
Key Words: cerebral arteries • occlusion • prognosis • thrombolytic therapy
This article has been cited by other articles:
 |
|
 |
|
  H. P. Mattle, M. Arnold, D. Georgiadis, C. Baumann, K. Nedeltchev, D. Benninger, L. Remonda, C. von Budingen, A. Diana, A. Pangalu, et al. Comparison of Intraarterial and Intravenous Thrombolysis for Ischemic Stroke With Hyperdense Middle Cerebral Artery Sign Stroke, February 1, 2008; 39(2): 379 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. King, P. Khatri, J. Carrozella, J. Spilker, J. Broderick, M. Hill, T. Tomsick, and for the IMS & IIMS II Investigators Anterior Cerebral Artery Emboli in Combined Intravenous and Intra-arterial rtPA Treatment of Acute Ischemic Stroke in the IMS I and II Trials AJNR Am. J. Neuroradiol., November 1, 2007; 28(10): 1890 - 1894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-H. Rha and J. L. Saver The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis Stroke, March 1, 2007; 38(3): 967 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Saqqur, K. Uchino, A. M. Demchuk, C. A. Molina, Z. Garami, S. Calleja, N. Akhtar, F. O. Orouk, A. Salam, A. Shuaib, et al. Site of Arterial Occlusion Identified by Transcranial Doppler Predicts the Response to Intravenous Thrombolysis for Stroke Stroke, March 1, 2007; 38(3): 948 - 954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.A. Christoforidis, Y. Mohammad, B. Avutu, A. Tejada, and A.P. Slivka Arteriographic Demonstration of Slow Antegrade Opacification Distal to a Cerebrovascular Thromboembolic Occlusion Site As a Favorable Indicator for Intra-Arterial Thrombolysis AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1528 - 1531. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Marti-Fabregas, M. Borrell, D. Cocho, R. Belvis, M. Castellanos, J. Montaner, J. Pagonabarraga, A. Aleu, L. Molina-Porcel, J. Diaz-Manera, et al. Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA Neurology, August 9, 2005; 65(3): 366 - 370. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Christoforidis, Y. Mohammad, D. Kehagias, B. Avutu, and A. P. Slivka Angiographic Assessment of Pial Collaterals as a Prognostic Indicator Following Intra-arterial Thrombolysis for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1789 - 1797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, J. I. Suarez, J. L. Sunshine, R. W. Tarr, M. J. Alexander, T. P. Smith, D. S. Enterline, W. R. Selman, and D. M. D. Landis Thrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 880 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Hjort, K. Butcher, S.M. Davis, C.S. Kidwell, on behalf of the UCLA Thrombolysis Investigators, W.J. Koroshetz, J. Rother, P.D. Schellinger, S. Warach, and L. Ostergaard Magnetic Resonance Imaging Criteria for Thrombolysis in Acute Cerebral Infarct Stroke, February 1, 2005; 36(2): 388 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Zhang, Z. G. Zhang, C. Zhang, R. L. Zhang, and M. Chopp Intravenous Administration of a GPIIb/IIIa Receptor Antagonist Extends the Therapeutic Window of Intra-Arterial Tenecteplase-Tissue Plasminogen Activator in a Rat Stroke Model Stroke, December 1, 2004; 35(12): 2890 - 2895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-H. Kwon, S. U. Kwon, J. H. Lee, C. G. Choi, D. C. Suh, and J. S. Kim Factors Affecting the Angiographic Recanalization and Early Clinical Improvement in Middle Cerebral Artery Territory Infarction After Thrombolysis Arch Neurol, November 1, 2004; 61(11): 1682 - 1686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sorimachi, Y. Fujii, N. Tsuchiya, T. Nashimoto, A. Harada, Y. Ito, and R. Tanaka Recanalization by Mechanical Embolus Disruption during Intra-Arterial Thrombolysis in the Carotid Territory AJNR Am. J. Neuroradiol., September 1, 2004; 25(8): 1391 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Georgiadis, J. Oehler, S. Schwarz, V. Rousson, M. Hartmann, and S. Schwab Does acute occlusion of the carotid T invariably have a poor outcome? Neurology, July 13, 2004; 63(1): 22 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Kim, N. J. Fischbein, Y. Lu, D. Pham, and W. P. Dillon Regional Angiographic Grading System for Collateral Flow: Correlation With Cerebral Infarction in Patients With Middle Cerebral Artery Occlusion Stroke, June 1, 2004; 35(6): 1340 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Moriguchi, T. Aoki, K. Mihara, N. Tojo, N. Matsuoka, and S. Mutoh Antithrombotic Effects of FK419, a Novel Nonpeptide Platelet GPIIb/IIIa Antagonist, in a Guinea Pig Photochemically Induced Middle Cerebral Artery Thrombosis Model: Comparison with Ozagrel and Argatroban J. Pharmacol. Exp. Ther., March 1, 2004; 308(3): 1094 - 1101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, R. du Mesnil de Rochemont, J.B. Fiebach, A. Gass, C. Nolte, T. Kucinski, J. Rother, M. Siebler, O.C. Singer, K. Szabo, et al. Effect of Incomplete (Spontaneous and Postthrombolytic) Recanalization After Middle Cerebral Artery Occlusion: A Magnetic Resonance Imaging Study Stroke, January 1, 2004; 35(1): 109 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Brozici, A. van der Zwan, and B. Hillen Anatomy and Functionality of Leptomeningeal Anastomoses: A Review Stroke, November 1, 2003; 34(11): 2750 - 2762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T. Higashida and A. J. Furlan Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke Stroke, August 1, 2003; 34 (8): e109 - e137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Arnold, K Nedeltchev, H P Mattle, T J Loher, F Stepper, G Schroth, C Brekenfeld, M Sturzenegger, and L Remonda Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions J. Neurol. Neurosurg. Psychiatry, June 1, 2003; 74(6): 739 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, J. I. Suarez, C. Santillan, J. L. Sunshine, R. W. Tarr, V. H. Paras, W. R. Selman, D. M.D. Landis, and D. D. Tong Response to Intra-Arterial and Combined Intravenous and Intra-Arterial Thrombolytic Therapy in Patients With Distal Internal Carotid Artery Occlusion * Editorial Comment Stroke, July 1, 2002; 33(7): 1821 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, G. Schroth, K. Nedeltchev, T. Loher, L. Remonda, F. Stepper, M. Sturzenegger, and H. P. Mattle Intra-Arterial Thrombolysis in 100 Patients With Acute Stroke Due to Middle Cerebral Artery Occlusion Stroke, July 1, 2002; 33(7): 1828 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Montaner, S. Abilleira, J. F. Arenillas, M. Ribo, R. Huertas, F. Romero, and J. Alvarez-Sabin Time Course of Tissue Plasminogen Activator-Induced Recanalization in Acute Cardioembolic Stroke: A Case-Control Study Stroke, December 1, 2001; 32(12): 2821 - 2827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kasner, A. M. Demchuk, J. Berrouschot, E. Schmutzhard, L. Harms, P. Verro, J. A. Chalela, R. Abbur, H. McGrade, I. Christou, et al. Predictors of Fatal Brain Edema in Massive Hemispheric Ischemic Stroke Stroke, September 1, 2001; 32(9): 2117 - 2123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Montaner, S. Abilleira, B. Ibarra, F. Romero, J. F. Arenillas, and J. Alvarez-Sabin Timing of Spontaneous Recanalization and Risk of Hemorrhagic Transformation in Acute Cardioembolic Stroke Stroke, May 1, 2001; 32(5): 1079 - 1084. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. Cross III, C. P. Derdeyn, and C. J. Moran Bleeding Complications after Basilar Artery Fibrinolysis with Tissue Plasminogen Activator AJNR Am. J. Neuroradiol., March 1, 2001; 22(3): 521 - 525. [Abstract] [Full Text]
|
|
|
|
|
|
T. Gerriets, E. Stolz, S. Konig, S. Babacan, I. Fiss, M. Jauss, and M. Kaps Sonographic Monitoring of Midline Shift in Space-Occupying Stroke : An Early Outcome Predictor Stroke, February 1, 2001; 32(2): 442 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Gerriets, T. Postert, M. Goertler, E. Stolz, F. Schlachetzki, U. Sliwka, G. Seidel, S. Weber, and M. Kaps DIAS I: Duplex-Sonographic Assessment of the Cerebrovascular Status in Acute Stroke : A Useful Tool for Future Stroke Trials Stroke, October 1, 2000; 31(10): 2342 - 2345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. von Kummer, S. C. Jones, T. A. Kent, and D. K. Kim The Time Concept in Ischemic Stroke: Misleading Response Stroke, October 1, 2000; 31 (10): 2517 - 2527. [Full Text] [PDF]
|
|
|
|
|
|
K. H. Lee, S.-J. Cho, H. S. Byun, D. G. Na, N.-C. Choi, S. J. Lee, I.-S. Jin, T. G. Lee, and C.-S. Chung Triphasic Perfusion Computed Tomography in Acute Middle Cerebral Artery Stroke: A Correlation With Angiographic Findings Arch Neurol, July 1, 2000; 57(7): 990 - 999. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. H. Lee, S. J. Lee, S.-J. Cho, D. G. Na, H. S. Byun, Y.-B. Kim, H.-J. Song, I.-S. Jin, and C.-S. Chung Usefulness of Triphasic Perfusion Computed Tomography for Intravenous Thrombolysis With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Arch Neurol, July 1, 2000; 57(7): 1000 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Berrouschot, H. Barthel, S. Hesse, W. H. Knapp, D. Schneider, and R. von Kummer Reperfusion and Metabolic Recovery of Brain Tissue and Clinical Outcome After Ischemic Stroke and Thrombolytic Therapy Stroke, July 1, 2000; 31(7): 1545 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, O. Jansen, J. B. Fiebach, S. Heiland, T. Steiner, S. Schwab, O. Pohlers, H. Ryssel, K. Sartor, and W. Hacke Monitoring Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Ischemic Stroke With Diffusion and Perfusion MRI Stroke, June 1, 2000; 31(6): 1318 - 1328. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Flacke, H. Urbach, E. Keller, F. Träber, A. Hartmann, J. Textor, J. Gieseke, W. Block, P. J. M. Folkers, and H. H. Schild Middle Cerebral Artery (MCA) Susceptibility Sign at Susceptibility-based Perfusion MR Imaging: Clinical Importance and Comparison with Hyperdense MCA Sign at CT Radiology, May 1, 2000; 215(2): 476 - 482. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. Davis and D. Barer Neuroprotection in acute ischaemic stroke. II: Clinical potential Vascular Medicine, August 1, 1999; 4(3): 149 - 163. [Abstract] [PDF]
|
|
|
|
|
|
P. Trouillas, N. Nighoghossian, L. Derex, P. Adeleine, J. Honnorat, P. Neuschwander, G. Riche, J.-C. Getenet, W. Li, J.-C. Froment, et al. Thrombolysis With Intravenous rtPA in a Series of 100 Cases of Acute Carotid Territory Stroke : Determination of Etiological, Topographic, and Radiological Outcome Factors Stroke, December 1, 1998; 29(12): 2529 - 2540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.-I. Kawano, Y. Ikeda, K. Kondo, and K. Umemura Increased cerebral infarction by cyclic flow reductions: studies in the guinea pig MCA thrombosis model Am J Physiol Regulatory Integrative Comp Physiol, November 1, 1998; 275(5): R1578 - R1583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gonner, L. Remonda, H. Mattle, M. Sturzenegger, C. Ozdoba, K.-O. Lovblad, R. Baumgartner, C. Bassetti, and G. Schroth Local Intra-Arterial Thrombolysis in Acute Ischemic Stroke Stroke, September 1, 1998; 29(9): 1894 - 1900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Wildermuth, M. Knauth, T. Brandt, R. Winter, K. Sartor, and W. Hacke Role of CT Angiography in Patient Selection for Thrombolytic Therapy in Acute Hemispheric Stroke Stroke, May 1, 1998; 29(5): 935 - 938. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Fisher and J. Bogousslavsky Further Evolution Toward Effective Therapy for Acute Ischemic Stroke JAMA, April 22, 1998; 279(16): 1298 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Infeld, S. M. Davis, G. A. Donnan, M. Lichtenstein, A. E. Baird, D. Binns, P. J. Mitchell, and J. L. Hopper Streptokinase Increases Luxury Perfusion After Stroke Stroke, September 1, 1996; 27(9): 1524 - 1529. [Abstract] [Full Text]
|
|
|
|
|
|
T. Brandt, R. von Kummer, M. Muller-Kuppers, and W. Hacke Thrombolytic Therapy of Acute Basilar Artery Occlusion : Variables Affecting Recanalization and Outcome Stroke, May 1, 1996; 27(5): 875 - 881. [Abstract] [Full Text]
|
|
|
|
|
|
J.C. Baron, R. von Kummer, and G.J. del Zoppo Treatment of Acute Ischemic Stroke : Challenging the Concept of a Rigid and Universal Time Window Stroke, December 1, 1995; 26(12): 2219 - 2221. [Full Text]
|
|