Distance to Thrombus in Acute Middle Cerebral Artery Occlusion A Predictor of Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke

This would be essential if we are ever to get an objective damage diagnosis and then we could look at the stroke protocols that solved those problems. My doctor told me almost nothing but I believe he said I had an MCA infarct. Of course none of my therapists ever saw a CT/MRI scan so there was nothing they could match up damages with exercises.
http://stroke.ahajournals.org/content/early/2015/02/03/STROKEAHA.114.008454.abstract?

1. Benjamin Friedrich, MD*,
2. Matthias Gawlitza, MD,
3. Stefan Schob, MD,
4. Carsten Hobohm, MD,
5. Mariana Raviolo, MD,
6. Karl-Titus Hoffmann, MD and
7. Donald Lobsien, MD*

+ Author Affiliations

1. From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.

1. Correspondence to Donald Lobsien, MD, Department of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany. E-mail donald.lobsien@medizin.uni-leipzig.de

1. ↵* Drs Friedrich and Lobsien contributed equally.

Abstract

Background and Purpose—In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion.

Methods—Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed.

Results—DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001).

Conclusion—DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.