Infarct core expansion on computed tomography before and after intravenous thrombolysis

Dongbeom Song, Joonsang Yoo, Jang Hyun Baek, Jinkwon Kim, Hye Sun Lee, Young Dae Kim, Hyo Suk Nam, Ji Hoe Heo

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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, respec-tively) 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.

Original languageEnglish
Pages (from-to)310-316
Number of pages7
JournalYonsei medical journal
Volume59
Issue number2
DOIs
Publication statusPublished - 2018 Mar

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All Science Journal Classification (ASJC) codes

  • Medicine(all)

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