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From the Departments of Neurology (S.W., T.B., R.W., W.H.) and
Neuroradiology (M.K., K.S.), University of Heidelberg, Heidelberg, Germany.
Correspondence to Susanne Wildermuth, MD, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. E-mail susanne_wildermuth{at}krzmail.krz.uni-heidelberg.de
Background and Purpose—It has been
shown that thrombolytic therapy can improve clinical
outcome in a subgroup of patients with acute cerebral ischemia.
This subgroup was characterized by certain clinical and imaging
findings (eg, moderate to severe neurological deficit for less than 3
to 6 hours, occlusion of the middle cerebral artery, lack of extended
infarct signs on CT, and efficient leptomeningeal collaterals).
Although not part of published prospective randomized rtPA trials,
information about the status of the brain vessels would be helpful in
the selection of patients who may benefit the most. Our purpose was to
determine the feasibility of CT angiography (CTA) in patients with
acute hemispheric ischemia and to evaluate its relevance for
thrombolytic therapy.
Methods—CTA was performed in 40 consecutive patients (11 women
and 29 men; age range, 19 to 80 years) with moderate or severe symptoms
(National Institutes of Health Stroke Scale score of
Results—Images and 3-dimensional reconstructions of
diagnostic quality could be obtained in all patients.
Thirty-four patients had a vessel occlusion. The extent of
leptomeningeal collaterals correlated significantly with the outcome
after thrombolytic therapy
(rs=0.46, P<0.05). The
evaluation of diagnostic accuracy showed a high agreement
with US (22 of 22) and DSA (6 of 7).
Conclusions—CTA can provide important information for the
initiation of therapy in patients with acute hemispheric
ischemia. Identification of patients with autolyzed thrombi,
occlusion of the internal carotid artery bifurcation, and poor
leptomeningeal collaterals is feasible with the use of CTA. These
patients may have little potential for benefit from
thrombolytic therapy.
© 1998 American Heart Association, Inc.
Original Contributions
Role of CT Angiography in Patient Selection for Thrombolytic Therapy in Acute Hemispheric Stroke
8) of acute
hemispheric ischemia. CTA findings were compared with
Doppler ultrasonography (US; n=22) and intra-arterial
digital subtraction angiography (DSA; n=7). Twenty patients received
thrombolytic therapy, the remaining patients received
intravenous heparin.
Key Words: angiography • computed tomography • ischemia, cerebral • stroke • thrombolytic therapy
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