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Infarct Core Expansion on Computed Tomography before and after Intravenous Thrombolysis

 Dongbeom Song  ;  Joonsang Yoo  ;  Jang Hyun Baek  ;  Jinkwon Kim  ;  Hye Sun Lee  ;  Young Dae Kim  ;  Hyo Suk Nam  ;  Ji Hoe Heo 
 Yonsei Medical Journal, Vol.59(2) : 310-316, 2018 
Journal Title
 Yonsei Medical Journal 
Issue Date
Intravenous Administration ; Aged ; Brain Infarction/*diagnostic imaging/*therapy ; Computed Tomography Angiography ; Female ; Fibrinolytic Agents/therapeutic use ; Follow-Up Studies ; Humans ; Male ; *Thrombolytic Therapy ; X-Ray Computed/*methods Tomography ; Treatment Outcome
Acute stroke therapy ; CT scan ; collateral circulation ; ischemic stroke ; tissue plasminogen activator
PURPOSE: Infarct core can expand rapidly in acute stroke patients receiving intravenous tissue plasminogen activator (IV t-PA). We investigated changes in the extent of infarct core during IV t-PA treatment, and explored the associative factors of this infarct core expansion in patients with proximal artery occlusion. MATERIALS AND METHODS: We included patients who were considered for sequential intra-arterial therapy (IAT) due to occlusion of intracranial proximal artery after IV t-PA. Patients who had a baseline Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) >/=6 and who underwent two consecutive CT scans before and shortly after IV t-PA infusion were enrolled. Patients were classified into no, moderate, and marked expansion groups based on decreases in ASPECTS (0-1, 2-3, and >/=4, respectively) on follow-up CT. Collateral status was graded using CT angiography. RESULTS: Of the 104 patients, 16 (15.4%) patients showed moderate and 13 (12.5%) patients showed marked infarct core expansion on follow-up CT scans obtained at 71.1+/-19.1 min after baseline CT scan. Sixteen (15.4%) patients had an ASPECTS value <6 on the follow-up CT. None of the patients with marked expansion were independent at 3 months. Univariate analysis and ordinal logistic regression analysis demonstrated that the infarct core expansion was significantly associated with collateral status (p<0.001). CONCLUSION: Among patients who were considered for IAT after IV t-PA treatment, one out of every seven patients exhibited marked expansion of infarct core on follow-up CT before IAT. These patients tend to have poor collaterals and poor outcomes despite rescue IAT.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
김영대(Kim, Young Dae) ORCID logo https://orcid.org/0000-0001-5750-2616
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
송동범(Song, Dong Beom)
유준상(Yoo, Joon Sang)
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
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