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Failure of complete recanalization is associated with poor outcome after cardioembolic stroke.

Authors
 H. S. Nam  ;  K.-Y. Lee  ;  Y. D. Kim  ;  H.-Y. Choi  ;  H.-J. Cho  ;  M.-J. Cha  ;  C. M. Nam  ;  J. H. Heo 
Citation
 EUROPEAN JOURNAL OF NEUROLOGY, Vol.18(9) : 1171-1178, 2011 
Journal Title
 EUROPEAN JOURNAL OF NEUROLOGY 
ISSN
 1351-5101 
Issue Date
2011
MeSH
Aged ; Angiography, Digital Subtraction ; Female ; Heart Diseases/complications ; Humans ; Intracranial Embolism/drug therapy ; Intracranial Embolism/etiology ; Male ; Middle Aged ; Recovery of Function* ; Risk Factors ; Stroke/drug therapy* ; Stroke/pathology* ; Thrombolytic Therapy* ; Tissue Plasminogen Activator/therapeutic use ; Urokinase-Type Plasminogen Activator/therapeutic use
Keywords
cardiac embolism ; cerebral infarction ; prognosis ; thrombolytic therapy
Abstract
BACKGROUND:   Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. METHODS:   Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3 months. RESULTS:   Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). CONCLUSIONS:   In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2011.03360.x/abstract
DOI
10.1111/j.1468-1331.2011.03360.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Jung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Cho, Hyun Ji(조현지)
Cha, Myoung Jin(차명진)
Choi, Hye Yoen(최혜연)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93754
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