			Home About us Contact

Arterial Recanalization (arterial + recanalization)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Association of Pretreatment ASPECTS Scores with tPA-Induced Arterial Recanalization in Acute Middle Cerebral Artery Occlusion

JOURNAL OF NEUROIMAGING, Issue 1 2008
Georgios Tsivgoulis MD
ABSTRACT BACKGROUND AND PURPOSE The Alberta Stroke Program Early CT-Score (ASPECTS) assesses early ischemic changes within the middle cerebral artery (MCA) and predicts poor outcome and increased risk for thrombolysis-related symptomatic ICH. We evaluated the potential relationship between pretreatment ASPECTS and tPA-induced recanalization in patients with MCA occlusions. SUBJECTS & METHODS Consecutive patients with acute ischemic stroke due to MCA occlusion were treated with standard IV-tPA and assessed with transcranial Doppler (TCD) for arterial recanalization. Early recanalization was determined with previously validated Thrombolysis in Brain Ischemia (TIBI) flow-grading system at 120 minutes after tPA-bolus. All pretreatment CT-scans were prospectively scored by trained investigators blinded to TCD findings. Functional outcome at 3 months was evaluated using the modified Rankin Scale (mRS). RESULTS IV-tPA was administered in 192 patients (mean age 68 ± 14 years, median NIHSS-score 17). Patients with complete recanalization (n= 51) had higher median pretreatment ASPECTS (10, interquartile range 2) than patients with incomplete or absent recanalization (n= 141; median ASPECTS 9, interquartile range 3, P= .034 Mann-Whitney U-test). An ASPECTS ,6 was documented in 4% and 17% of patients with present and absent recanalization, respectively (P= .019). Pretreatment ASPECTS was associated with complete recanalization (OR per 1-point increase: 1.54; 95% CI 1.06,2.22, P= .023) after adjustment for baseline characteristics, risk factors, NIHSS-score, pretreatment TIBI grades and site of arterial occlusion on baseline TCD. Complete recanalization (OR: 33.97, 95% CI 5.95,185.99, P < .001) and higher ASPECTS (OR per 1-point increase: 1.91; 95% CI 1.17,3.14, P= .010) were independent predictors of good functional outcome (mRS 0,2). CONCLUSIONS Higher pretreatment ASPECT-scores are associated with a greater chance of complete recanalization and favorable long-term outcome in tPA-treated patients with acute MCA occlusion. [source]

Role of neuroimaging in promoting long-term recovery from ischemic stroke

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2010
Rüdiger J. Seitz MD
Abstract Human ischemic stroke is an acute disorder followed by a recovery period which may be of varying duration and mechanism. Imaging has created a means to explore the stroke process in vivo, particularly its underlying pathophysiology and recovery mechanisms. Evidence from multicenter studies has shown that, in the acute phase, arterial recanalization and reperfusion of ischemic brain tissue are the most important determinants of recovery. This is followed by functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks that continue with different dynamics for weeks to months. Proof-of-principle studies have revealed that the behavioral gains induced by rehabilitation are paralleled by changes in functional representations. This is supported by data from neuroimaging and electrophysiological studies early after stroke which have shown that dedicated training can induce changes in cerebral functional representations. Accordingly, there is clear evidence that neuroimaging has a significant potential for monitoring the hemodynamic, functional, and structural factors determining recovery from stroke. New imaging methods may provide relevant biomarkers for treatment decisions and therapeutic monitoring. By combining neuroimaging with electrophysiological measures, opportunities exist to develop neuroscience-based strategies in rehabilitation. J. Magn. Reson. Imaging 2010;32:756,772. © 2010 Wiley-Liss, Inc. [source]

Association of Pretreatment ASPECTS Scores with tPA-Induced Arterial Recanalization in Acute Middle Cerebral Artery Occlusion

Association of growth factors with arterial recanalization and clinical outcome in patients with ischemic stroke treated with tPA

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 7 2010
T. SOBRINO
Summary.,Background: Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and granulocyte-colony stimulating factor (G-CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. Objectives: To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. Methods: We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color-coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0,2 at 90 days. GF levels were determined by ELISA. Results: Mean serum levels of VEGF, G-CSF and Ang-1 at baseline were significantly higher in patients with early MCA recanalization (n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G-CSF (OR, 1.02) and Ang-1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) (n = 20) showed higher levels of Ang-1 (P < 0.0001). Ang-1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome (n = 38) had higher levels of G-CSF (P < 0.0001). G-CSF was independently associated with good outcome (OR, 1.12; P = 0.036). Conclusions: These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t-PA, although they might increase the HT. [source]