- Location of the Clot and Outcome of Perfusion Defects in Acute Anterior Circulation Stroke Treated with Intravenous Thrombolysis
These investigators studied the impact of clot location in patients with acute stroke receiving IV thrombolysis. Four locations (ICA, proximal M1, distal M1, and M2 segment and more distal) of clots were correlated with CT perfusion maps, mismatches, salvaged brain volumes, and outcomes in 105 patients. Clots that were more proximal in location produced larger perfusion defects and lesion volumes. The amount of tissue salvaged was greater in patients with more distally located clots. In conclusion, admission CBV defects were larger in proximal vessel occlusions. More of the penumbra was salvaged if the occlusion was located more distally. This effect reached a plateau in the distal M1 segment of the MCA.
- Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke
Predictors of clinically meaningful recanalization were assessed in 126 patients with acute anterior circulation stroke treated with IV thrombolysis. End points were CT angiographic recanalization and good clinical outcome at 90 days. Clinically meaningful recanalization occurred in 29% of patients, who had fewer neurologic deficits and higher ASPECTS at baseline. Admission NIHSS score and site of arterial occlusion were significant predictors of meaningful recanalization. Specifically, mild baseline deficits and distal vessel occlusions were significant predictors of clinically meaningful recanalization. A combination of these was better than either parameter alone.
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