title: Intravenous thrombolysis outcomes in patients presenting with large vessel acute ischemic strokes--CT angiography-based prognosis.
abstract: OBJECTIVE
  To establish outcome rates for patients receiving intravenous thrombolysis based on vascular occlusion site.
  
  
  METHODS
  This is a retrospective analysis of 225 patients who had received intravenous-rt-PA for anterior circulation strokes. The occlusion-site was prospectively determined on the admission computed tomographic angiography (CTA) and divided into: large vessel occlusion (LVO) including patients with an internal carotid artery terminus or middle cerebral artery (M1/proximal M2) occlusions and no large vessel occlusion (No-LVO; distal M2/M3/ACA) including patients with either distal or no occlusions. The primary outcome was the modified Rankin score (mRS) at 90-days with a good outcome defined by mRS of 0-2.000.
  
  
  RESULTS
  There were 114 (50.7%) patients in the LVO and 111 (49.3%) in the No-LVO group. A good outcome was seen in 28 (24.6%) patients in the LVO and 77 (69.4%) patients in the No-LVO group (OR .14; 95% CI: .08-.26; P < .0001). Mortality was observed in 13 (11.7%) patients in the No-LVO group and 48 (42.1%) patients in the LVO group (OR .18; 95% CI: .09-.36; P < .0001). Significant hemorrhage was seen in 14 (12.5%) patients in the LVO and 0 (0%) patients in the No-LVO group (P < .0001). Older age (OR .96; 95% CI: .93-.98; P = .002) and presence of LVO (OR .29; 95% CI: .12-.68; P = .004) were significant independent predictors of poor outcome.
  
  
  CONCLUSIONS
  CTA identification of proximal occlusions is associated with significantly poor outcomes in patients receiving intravenous stroke thrombolysis.
authors.affiliation: Radiology & Neurology, West Virginia University, Morgantown, WV.
authors.forename: Ansaar
authors.initials: A
authors.lastname: Rai
authors.affiliation: Neuroradiology, West Virginia University, Morgantown, WV.
authors.forename: Brendan
authors.initials: B
authors.lastname: Cline
authors.affiliation: Neuroradiology, West Virginia University, Morgantown, WV.
authors.forename: Eric
authors.initials: E
authors.lastname: Williams
authors.affiliation: Neuroradiology, West Virginia University, Morgantown, WV.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Carpenter
authors.affiliation: Neuroradiology, West Virginia University, Morgantown, WV.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roberts
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: CTA; Stroke; thrombolysis