title: Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke.
abstract: We tested the hypothesis that the type of vascular occlusion, recanalisation and collateralisation are predictive of outcome after thrombolytic therapy in acute ischaemic stroke. We carried out angiography and local intra-arterial (97) or systemic (14) thrombolysis within 6 h of the onset in patients with an ischaemic stroke in the territory of the internal carotid artery. Early ischaemic signs (EIS) on pretreatment CT and angiographic findings were classified and analysed in relation to clinical outcome at 3 months. A favourable outcome (Barthel index [BI]>/= 90) was found in 40% of patients with an occlusion of the middle cerebral artery trunk whereas intracranial occlusion of the internal carotid artery ("carotid T occlusion") was followed by death or severe disability (BI<50) in 87%. Significant univariate predictors of favourable outcome were occlusion type ( P<0.01), recanalisation ( P<0.01) and collateralisation ( P<0.01). However, multivariate analysis revealed a significant relationship only between collateralisation and favourable outcome (odds ratio 5.9, 95% confidence interval 1.3-26.7, P=0.02). EIS were not predictive in either case. Occlusion type and recanalisation, are related to outcome only if adequate collateralisation prevents infarction until recanalisation occurs.
authors.affiliation: Department of Neuroradiology, University-Hospital Hamburg Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany. kucinski@uke.uni-hamburg.de
authors.forename: T
authors.initials: T
authors.lastname: Kucinski
authors.forename: C
authors.initials: C
authors.lastname: Koch
authors.forename: B
authors.initials: B
authors.lastname: Eckert
authors.forename: V
authors.initials: V
authors.lastname: Becker
authors.forename: H
authors.initials: H
authors.lastname: Krömer
authors.forename: C
authors.initials: C
authors.lastname: Heesen
authors.forename: U
authors.initials: U
authors.lastname: Grzyska
authors.forename: H J
authors.initials: HJ
authors.lastname: Freitag
authors.forename: J
authors.initials: J
authors.lastname: Röther
authors.forename: H
authors.initials: H
authors.lastname: Zeumer
mesh_terms: D000208:Acute Disease; D000368:Aged; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography; D003097:Collateral Circulation; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator