Carotid Duplex Ultrasonography Can Predict Outcome of Intravenous Alteplase Therapy for Hyperacute Stroke
| Autor: | Kazuyuki Nagatsuka, Kazunori Toyoda, Takahiro Nakashima, Chiaki Yokota, Toshiyuki Uehara, BooHan Hyun, Hiroaki Naritomi, Kazuo Minematsu, Masatoshi Koga |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Emergency Medical Services medicine.medical_specialty Embolism Tissue plasminogen activator Brain Ischemia Diabetes Complications Brain ischemia Plasminogen Activators Predictive Value of Tests Modified Rankin Scale Internal medicine Odds Ratio medicine Humans Carotid Stenosis Prospective Studies cardiovascular diseases Prospective cohort study Stroke Aged Cerebral Hemorrhage Analysis of Variance Ultrasonography Doppler Duplex business.industry Rehabilitation Odds ratio medicine.disease Surgery Carotid Arteries Treatment Outcome Tissue Plasminogen Activator Carotid artery occlusion Acute Disease Injections Intravenous Cardiology Female Neurology (clinical) Safety Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 20:24-29 |
| ISSN: | 1052-3057 |
| Popis: | We evaluated whether carotid duplex ultrasonography (US) can help predict the safety and efficacy of treating hyperacute stroke with intravenous (IV) tissue plasminogen activator (alteplase) therapy. Consecutive patients with stroke were assigned to the carotid artery occlusion (CO) group or the other (non-CO) group according to US findings before or immediately after receiving IV alteplase. Effectiveness and safety outcomes included early neurologic improvement, defined as a reduction in a National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points within the initial 24 hours after stroke onset; completely independent routine activity, defined as a modified Rankin Scale score of ≤1 at day 90 after stroke onset; symptomatic intracranial hemorrhage (ICH) occurring within 36 hours after stroke onset; and any ICH. We enrolled 127 patients (27 in the CO group and 100 in the non-CO group) with a median baseline NIHSS score of 13 (range, 4-30). The CO group had a higher baseline NIHSS score (median, 18 vs 12; P=.005). After multivariate adjustment, the CO group was inversely associated with early improvement (odds ratio [OR]=0.26; 95% confidence interval [CI]=0.09-0.72) and independence at day 90 (OR=0.23; 95% CI=0.05-0.73) and positively associated with any ICH (OR=3.11; 95% CI=1.23-8.48). Our findings indicate that CO identified by US in the emergency clinical setting is an independent predictor of unfavorable outcome and ICH following IV alteplase therapy. |
| Databáze: | OpenAIRE |
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