当前位置： SCI文献检索 > STROKE期刊下所有文献 > Baseline magnetic resonance imaging parameters and stroke outcome in patients treated by intravenous tissue plasminogen activator.

Baseline magnetic resonance imaging parameters and stroke outcome in patients treated by intravenous tissue plasminogen activator.

Abstract：

BACKGROUND AND PURPOSE:We designed a prospective sequential pretreatment and posttreatment MRI study to assess the relation between neuroimaging parameters and clinical outcome in patients treated with intravenous recombinant tissue-type plasminogen activator (rtPA). METHODS:Patients with symptoms of acute hemispheric ischemic stroke were recruited. The National Institutes of Health Stroke Scale (NIHSS) score was assessed at baseline and at days 1, 7, and 60, and the modified Rankin scale (mRS) at day 60, by which outcome was classified in terms of independence (mRS score 0, 1, or 2) or severe disability or death (mRS score 3 through 6), was assigned. Multimodal stroke MRI was performed at presentation and repeated at day 1. MRI procedures included magnetic resonance angiography, T2* gradient-echo sequence, echoplanar imaging, and isotropic diffusion- (DWI) and perfusion-weighted (PWI) imaging. Patients were treated with intravenous rtPA after MRI completion. RESULTS:Twenty-nine patients (16 men and 13 women; mean+/-SD age, 65+/-14 years) underwent MRI; the mean time from symptom onset to treatment was 255+/-62 minutes. Twenty-six patients had a vessel occlusion, and 15 patients experienced a partial (Thrombolysis in Myocardial Infarction [TIMI]-2) or total (TIMI-3) recanalization at day 1, whereas 11 patients had a persistent occlusion. Mean NIHSS scores at day 60 were 5.7+/-5.4 if recanalization had occurred and 14+/-2 in cases of persistent occlusion. According to the mRS, 13 patients were independent (mRS 0 through 2), whereas severe disability or death (mRS 3 through 6) was observed in 15 patients. A better outcome was observed when recanalization was achieved (r=-0.68, P=0.0002). PWI volume and time to peak (TTP) within the DWI lesion assessed before therapy were correlated with day-60 NIHSS score (PWI volume: r=0.51, P=0.006, TTP: r=0.35, P=0.07). The day-0 DWI abnormality volume was well correlated with day-60 NIHSS score (r=0.58, P=0.001). Multiple regression linear analysis showed that 2 factors mainly influenced clinical outcome: (1) recanalization, with a high correlation with NIHSS score at day 60 (P=0.0001) and (2) day-0 DWI lesion volume, which is closely associated with day-60 NIHSS score (P=0.03). CONCLUSIONS:Baseline DWI volume and recanalization are the main factors influencing clinical outcome after rtPA for ischemic stroke.

journal_name

Stroke

journal_title

Stroke

authors

Nighoghossian N,Hermier M,Adeleine P,Derex L,Dugor JF,Philippeau F,Ylmaz H,Honnorat J,Dardel P,Berthezène Y,Froment JC,Trouillas P

doi

10.1161/01.str.0000053850.64877.af

subject

Has Abstract

pub_date

2003-02-01 00:00:00

pages

458-63

issue

eissn

0039-2499

issn

1524-4628

journal_volume

pub_type

临床试验,杂志文章

在线工具

Baseline magnetic resonance imaging parameters and stroke outcome in patients treated by intravenous tissue plasminogen activator.