This Article Full Text Full Text (PDF) All Versions of this Article: 39/5/1616    most recent STROKEAHA.107.504951v1 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 Thomalla, G. Articles by Fiehler, J. Search for Related Content PubMed PubMed Citation Articles by Thomalla, G. Articles by Fiehler, J. Related Collections Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging Thrombolysis

(Stroke. 2008;39:1616.)
© 2008 American Heart Association, Inc.

Research Letters

Clinical and Tissue Response to Intravenous Thrombolysis in Tandem Internal Carotid Artery/Middle Cerebral Artery Occlusion

An MRI Study

Götz Thomalla, MD; Anna Kruetzelmann, MD; Susanne Siemonsen, MD; Christian Gerloff, MD; Michael Rosenkranz, MD; Joachim Röther, MD Jens Fiehler, MD

From Klinik und Poliklinik für Neurologie (G.T., A.K., C.G., M.R.), Neuro-Zentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Neuroradiologische Abteilung (S.S., J.F.), Klinik und Poliklinik für Radiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Neurologische Klinik (J.R.), Klinikum Minden, Minden, Germany.

Correspondence to Götz Thomalla, Neuro-Zentrum, Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany. E-mail thomalla{at}uke.uni-hamburg.de

Background and Purpose— The benefit of intravenous thrombolysis in tandem internal carotid artery (ICA)/middle cerebral artery (MCA) occlusion remains unclear. We studied clinical and imaging outcome of intravenous thrombolysis in MRI-selected patients with tandem ICA/MCA occlusion as compared to isolated MCA occlusion.

Methods— We analyzed data of MRI-selected acute ischemic stroke patients treated with intravenous tissue plasminogen activator within 6 hours. Initial perfusion and diffusion lesion volumes were calculated. Final infarct volume was assessed on follow-up imaging after 5 to 8 days. Recanalization/reperfusion was assessed after 24 hours using MRA. Favorable outcome was defined as a modified Rankin scale score of 0 to 1 after 90 days.

Results— Of 38 patients with proximal MCA occlusion, 14 (37%) had a tandem ICA/MCA occlusion. Median NIHSS on admission (15 vs 15), initial perfusion (246 vs 246 mL), and diffusion lesion volume (22 vs 21 mL), final infarct volume (30 vs 39 mL), and the proportion of patients with a favorable outcome after 3 months (50% vs 46%) were similar in tandem ICA/MCA occlusion versus isolated MCA occlusion.

Conclusion— The presence of tissue at risk appears to play a key role for the likelihood of clinical recovery after intravenous tissue plasminogen activator treatment in acute stroke patients with tandem ICA/MCA occlusion. There appears to be no evidence to exclude patients with tandem ICA/MCA occlusion from intravenous thrombolysis.

Key Words: acute ischemic stroke • carotid artery occlusion • magnetic resonance imaging • middle cerebral artery occlusion • outcome • thrombolytic therapy

This article has been cited by other articles:

				W.-D. Heiss and A. G. Sorensen Advances in Imaging Stroke, May 1, 2009; 40(5): e313 - e314. [Full Text] [PDF]