title: Distance to thrombus in acute middle cerebral artery occlusion: a predictor of outcome after intravenous thrombolysis for acute ischemic stroke.
abstract: OBJECTIVE
  In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion.
  
  
  METHODS
  Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed.
  
  
  RESULTS
  DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001).
  
  
  CONCLUSIONS
  DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.
authors: Benjamin
authors: B
authors: Friedrich
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.
authors: Matthias
authors: M
authors: Gawlitza
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.
authors: Stefan
authors: S
authors: Schob
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.
authors: Carsten
authors: C
authors: Hobohm
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.
authors: Mariana
authors: M
authors: Raviolo
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany.
authors: Karl-Titus
authors: KT
authors: Hoffmann
authors: From the Department of Interventional and Diagnostic Radiology (B.F., M.G., M.R.), Department of Neuroradiology (S.S., K.-T.H., D.L.), and Department of Neurology (C.H.), University Hospital Leipzig, Germany. donald.lobsien@medizin.uni-leipzig.de.
authors: Donald
authors: D
authors: Lobsien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002339:Carotid Arteries / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: middle cerebral artery occlusion; outcomes assessment; stroke; thrombosis