This Article Full Text Full Text (PDF) All Versions of this Article: 35/5/1135    most recent 01.STR.0000125862.55804.29v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arnold, M. Articles by Mattle, H. Search for Related Content PubMed PubMed Citation Articles by Arnold, M. Articles by Mattle, H. Related Collections Other arteriosclerosis Acute Stroke Syndromes Emergency treatment of Stroke Angiography Thrombolysis

(Stroke. 2004;35:1135.)
© 2004 American Heart Association, Inc.

Original Contributions

Outcome of Acute Stroke Patients Without Visible Occlusion on Early Arteriography

Marcel Arnold, MD; Krassen Nedeltchev, MD; Caspar Brekenfeld, MD; Urs Fischer, MD; Luca Remonda, MD; Gerhard Schroth, MD Heinrich Mattle, MD

From Departments of Neurology (M.A., K.N., U.F., H.M.) and Neuroradiology (C.B., L.R., G.S.), University of Bern, Bern, Switzerland.

Correspondence to Dr Heinrich Mattle, Department of Neurology, University of Berne, Freiburgstrasse, Inselspital, CH-3010 Berne, Switzerland. E-mail heinrich.mattle{at}insel.ch

Background— The aim of this study was to determine the clinical and radiological outcome of acute stroke patients who had no vessel occlusion on arteriography and to define predictors of clinical outcome.

Methods— We analyzed clinical and radiological data of stroke patients whose arteriography performed within 6 hours of symptom onset did not visualize any vessel occlusion.

Results— Twenty-eight of 283 consecutive patients (10%) who underwent arteriography with the intention to perform intraarterial thrombolysis did not show any arterial occlusion. Their median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Time from symptom onset to arteriography ranged from 115 to 315 minutes; on average, it was 226 minutes. Presumed stroke cause was cardiac embolism in 11 patients (39%), small artery disease in 6 (21%), coronary angiography in 1 (4%), and undetermined in 10 patients (36%). After 3 months, modified Rankin Scale score (mRS) was 2 in 21 patients (75%), indicating a favorable outcome. Six patients (21%) had a poor outcome (mRS 3 or 4) and 1 patient (4%) had a myocardial infarction and died. Twenty-seven patients had follow-up brain imaging. It was normal in 5, showed a lacunar lesion in 8, a striatocapsular infarct in 2, a small or medium-sized anterior circulation infarct in 6, multiple small anterior circulation infarcts in 2, and multiple posterior circulation infarcts in 4. No predictors of clinical outcome were identified.

Conclusions— Most acute stroke patients with normal early arteriography show infarcts on brain imaging; however, clinical outcome is usually favorable.

Key Words: stroke • outcome • thrombolysis

This article has been cited by other articles:

				L. R. Caplan Stroke Thrombolysis: Slow Progress Circulation, July 18, 2006; 114(3): 187 - 190. [Full Text] [PDF]

				U. Fischer, M. Arnold, K. Nedeltchev, C. Brekenfeld, P. Ballinari, L. Remonda, G. Schroth, and H. P. Mattle NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke Stroke, October 1, 2005; 36(10): 2121 - 2125. [Abstract] [Full Text] [PDF]