Yonsei Med J.  2018 Mar;59(2):310-316. 10.3349/ymj.2018.59.2.310.

Infarct Core Expansion on Computed Tomography before and after Intravenous Thrombolysis

Affiliations
  • 1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. jhheo@yuhs.ac
  • 2Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 3Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Infarct core can expand rapidly in acute stroke patients receiving intravenous tissue plasminogen activator (IV t-PA). We investigated changes in the extent of infarct core during IV t-PA treatment, and explored the associative factors of this infarct core expansion in patients with proximal artery occlusion.
MATERIALS AND METHODS
We included patients who were considered for sequential intra-arterial therapy (IAT) due to occlusion of intracranial proximal artery after IV t-PA. Patients who had a baseline Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) ≥6 and who underwent two consecutive CT scans before and shortly after IV t-PA infusion were enrolled. Patients were classified into no, moderate, and marked expansion groups based on decreases in ASPECTS (0-1, 2-3, and ≥4, respectively) on follow-up CT. Collateral status was graded using CT angiography.
RESULTS
Of the 104 patients, 16 (15.4%) patients showed moderate and 13 (12.5%) patients showed marked infarct core expansion on follow-up CT scans obtained at 71.1±19.1 min after baseline CT scan. Sixteen (15.4%) patients had an ASPECTS value < 6 on the follow-up CT. None of the patients with marked expansion were independent at 3 months. Univariate analysis and ordinal logistic regression analysis demonstrated that the infarct core expansion was significantly associated with collateral status (p < 0.001).
CONCLUSION
Among patients who were considered for IAT after IV t-PA treatment, one out of every seven patients exhibited marked expansion of infarct core on follow-up CT before IAT. These patients tend to have poor collaterals and poor outcomes despite rescue IAT.

Keyword

Acute stroke therapy; ischemic stroke; CT scan; collateral circulation; tissue plasminogen activator

MeSH Terms

Administration, Intravenous
Aged
Brain Infarction/*diagnostic imaging/*therapy
Computed Tomography Angiography
Female
Fibrinolytic Agents/therapeutic use
Follow-Up Studies
Humans
Male
*Thrombolytic Therapy
Tomography, X-Ray Computed/*methods
Treatment Outcome
Fibrinolytic Agents

Figure

  • Fig. 1 Distribution of ASPECTS on initial and follow-up CT images. ASPECTS, Alberta Stroke Program Early Computed Tomography Score; CT, computed tomography.

  • Fig. 2 Difference in ASPECTS on consecutive CT scans according to collateral status. ASPECTS, Alberta Stroke Program Early Computed Tomography Score; CT, computed tomography; CTA, CT angiography.


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