Carotid duplex ultrasonography can predict outcome of intravenous alteplase therapy for hyperacute stroke.
We evaluated whether carotid duplex ultrasonography (US) can help predict the safety and efficacy of treating hyperacute stroke with intravenous (IV) tissue plasminogen activator (alteplase) therapy. Consecutive patients with stroke were assigned to the carotid artery occlusion (CO) group or the other (non-CO) group according to US findings before or immediately after receiving IV alteplase. Effectiveness and safety outcomes included early neurologic improvement, defined as a reduction in a National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points within the initial 24 hours after stroke onset; completely independent routine activity, defined as a modified Rankin Scale score of ≤1 at day 90 after stroke onset; symptomatic intracranial hemorrhage (ICH) occurring within 36 hours after stroke onset; and any ICH. We enrolled 127 patients (27 in the CO group and 100 in the non-CO group) with a median baseline NIHSS score of 13 (range, 4-30). The CO group had a higher baseline NIHSS score (median, 18 vs 12; P=.005). After multivariate adjustment, the CO group was inversely associated with early improvement (odds ratio [OR]=0.26; 95% confidence interval [CI]=0.09-0.72) and independence at day 90 (OR=0.23; 95% CI=0.05-0.73) and positively associated with any ICH (OR=3.11; 95% CI=1.23-8.48). Our findings indicate that CO identified by US in the emergency clinical setting is an independent predictor of unfavorable outcome and ICH following IV alteplase therapy.
Koga
Masatoshi
M
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan. Electronic address: koga@hsp.ncvc.go.jp.
Toyoda
Kazunori
K
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Nakashima
Takahiro
T
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Hyun
Boo-Han
BH
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Uehara
Toshiyuki
T
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Yokota
Chiaki
C
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Nagatsuka
Kazuyuki
K
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Naritomi
Hiroaki
H
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Minematsu
Kazuo
K
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000150:complications; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications; D002543:Cerebral Hemorrhage / Q000150:complications; D048909:Diabetes Complications / Q000628:therapy; D004617:Embolism / Q000188:drug therapy; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D016017:Odds Ratio; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012449:Safety; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator