| Full text | |
| Author(s): |
Nogueira, Ricardo C.
[1]
;
Bor-Seng-Shu, Edson
[2]
;
Saeed, Nazia P.
[3]
;
Teixeira, Manoel J.
[2]
;
Panerai, Ronney B.
[3, 4]
;
Robinson, Thompson G.
[3, 4]
Total Authors: 6
|
| Affiliation: | [1] Univ Sao Paulo, Sch Med, Hosp Clin, Dept Neurol, Sao Paulo - Brazil
[2] Univ Sao Paulo, Sch Med, Hosp Clin, Dept Neurosurg, Sao Paulo - Brazil
[3] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics - England
[4] Glenfield Hosp, Biomed Res Unit Cardiovasc Sci, Leicester, Leics - England
Total Affiliations: 4
|
| Document type: | Review article |
| Source: | FRONTIERS IN NEUROLOGY; v. 7, MAY 18 2016. |
| Web of Science Citations: | 5 |
| Abstract | |
Background: The present review investigated which findings in vascular imaging techniques can be used to predict clinical outcome and the risk of symptomatic intracerebral hemorrhage (sICH) in patients who underwent intravenous thrombolytic treatment. Methods: Publications were searched, and the inclusion criteria were as follows: (1) published manuscripts, (2) patients with acute ischemic stroke managed with intravenous recombinant tissue plasminogen activator (rtPA), and (3) availability of imaging assessment to determine vessel patency or the regulation of cerebral blood flow prior to, during, and/or after thrombolytic treatment. Clinical outcomes were divided into neurological outcome {[}National Institutes of Health Stroke Scale (NIHSS) within 7 days] and functional outcome (modified Rankin score in 2-3 months). sICH was defined as rtPA-related intracerebral bleeding associated with any worsening of NIHSS. Results: Thirty-nine articles were selected. Recanalization was associated with improved neurological and functional outcomes (OR = 7.83; 95% CI, 3.71-16.53; p < 0.001 and OR = 11.12; 95% CI, 5.85-21.14; p < 0.001, respectively). Both tandem internal carotid artery/middle cerebral artery (ICA/MCA) occlusions and isolated ICA occlusion had worse functional outcome than isolated MCA occlusion (OR = 0.26, 95% CI, 0.12-0.52; p < 0.001 and OR = 0.24, 95% CI, 0.07-0.77; p = 0.016, respectively). Reocclusion was associated with neurological deterioration (OR = 6.48, 95% CI, 3.64-11.56; p < 0.001), and early recanalization was associated with lower odds of sICH (OR = 0.36, 95% CI, 0.18-0.70; p = 0.003). Conclusion: Brain circulation data before, during, and after thrombolysis may be useful for predicting the clinical outcome. Cerebral arterial recanalization, presence and site of occlusion, and reocclusion are all important in predicting the clinical outcome. (AU) | |
| FAPESP's process: | 13/25953-0 - Cerebral autoregulation in the acute and subacute phase of ischemic stroke patients submitted to thrombolysis |
| Grantee: | Ricardo de Carvalho Nogueira |
| Support Opportunities: | Regular Research Grants |