title: Length of occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke.
abstract: OBJECTIVE
  The length of large vessel occlusion is considered a major factor for therapy in patients with ischemic stroke. We used 4D-CT angiography evaluation of middle cerebral artery occlusion in prediction of recanalization and favorable clinical outcome and after intravenous thrombolysis (IV-tPA).
  
  
  METHODS
  In 80 patients treated with IV-tPA for acute complete middle cerebral artery/M1 occlusion determined using CT angiography and temporal maximum intensity projection, calculated from 4D-CT angiography, the length of middle cerebral artery proximal stump, occlusion in M1 or M1 and M2 segment were measured. Univariate and multivariate analyses were performed to define independent predictors of successful recanalization after 24 hours and favorable outcome after 3 months.
  
  
  RESULTS
  The length of occlusion was measureable in all patients using temporal maximum intensity projection. Recanalization thrombolysis in myocardial infarction 2 to 3 was achieved in 37 individuals (46%). The extension to M2 segment as a category (odds ratio, 4.58; 95% confidence interval, 1.39-15.05; P=0.012) and the length of M1 segment occlusion (odds ratio, 0.82; 95% confidence interval, 0.73-0.92; P=0.0007) with an optimal cutoff value of 12 mm (sensitivity 0.67; specificity 0.71) were significant independent predictors of recanalization. Favorable outcome (modified Rankin scale 0-2) was achieved in 25 patients (31%), baseline National Institutes of Health Stroke Scale (odds ratio, 0.82; 95% confidence interval, 0.72-0.93; P=0.003) and the length of occlusion M1 in segment (odds ratio, 0.79; 95% confidence interval, 0.69-0.91; P=0.0008) with an optimal cutoff value of 11 mm (sensitivity 0.74; specificity 0.76) were significant independent predictors of favorable outcome.
  
  
  CONCLUSIONS
  The length of middle cerebral artery occlusion is an independent predictor of successful IV-tPA treatment.
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.). rohan@fnplzen.cz.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Rohan
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Jan
authors.initials: J
authors.lastname: Baxa
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Radek
authors.initials: R
authors.lastname: Tupy
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Lenka
authors.initials: L
authors.lastname: Cerna
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Petr
authors.initials: P
authors.lastname: Sevcik
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Michal
authors.initials: M
authors.lastname: Friesl
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Jiri
authors.initials: J
authors.lastname: Polivka
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Jiri
authors.initials: J
authors.lastname: Polivka
authors.affiliation: From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
authors.forename: Jiri
authors.initials: J
authors.lastname: Ferda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D056973:Four-Dimensional Computed Tomography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: computed tomography; middle cerebral artery; outcome; stroke; thrombolytic therapy