title: Posterior cerebral artery laterality on magnetic resonance angiography predicts long-term functional outcome in middle cerebral artery occlusion.
abstract: OBJECTIVE
  Prominent posterior cerebral artery (PCA) laterality upon 3-dimensional time-of-flight magnetic resonance angiography is often encountered in patients with middle cerebral artery occlusion. We hypothesized that this sign is correlated with improved functional outcome in patients with middle cerebral artery occlusion treated with intravenous recombinant tissue plasminogen activator.
  
  
  METHODS
  Fifty acute ischemic stroke patients with middle cerebral artery occlusion were treated with intravenous recombinant tissue plasminogen activator from April 2007 to October 2009. All patients routinely underwent initial (first 3 hours) magnetic resonance scans on admission, and additional follow-up (14-21 days after stroke onset) computed tomography scans. Two film readers blinded to all clinical information assessed the presence or absence of PCA laterality on magnetic resonance angiography. We retrospectively analyzed the clinical and radiologic data on all patients.
  
  
  RESULTS
  Out of 50 patients, 20 showed PCA laterality on magnetic resonance angiography. National Institute of Health Stroke Scale score 7 days after stroke onset was significantly lower (P=0.007), and infarct volume on follow-up computed tomography was significantly smaller (P=0.009) in patients with PCA laterality than in patients without this sign. Multivariate logistic regression analyses showed an adjusted odds ratio of 8.49 for a favorable outcome (modified Rankin Scale score 0-1 at 6 months) in patients with PCA laterality (95% CI: 1.82 to 55.8, P=0.005).
  
  
  CONCLUSIONS
  The presence of PCA laterality on magnetic resonance angiography before intravenous recombinant tissue plasminogen activator can be used as a predictor of favorable functional outcome in patients with middle cerebral artery occlusion, probably due to improvement of recanalization rate.
authors.affiliation: Department of Neurology and Neurological Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo 113-0034, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ichijo
authors.forename: Kazunori
authors.initials: K
authors.lastname: Miki
authors.forename: Satoru
authors.initials: S
authors.lastname: Ishibashi
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kamata
authors.forename: Hiroto
authors.initials: H
authors.lastname: Fujigasaki
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Mizusawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000473:pathology*; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator