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Research ArticleBrain

Location of the Clot and Outcome of Perfusion Defects in Acute Anterior Circulation Stroke Treated with Intravenous Thrombolysis

N. Sillanpää, J.T. Saarinen, H. Rusanen, I. Elovaara, P. Dastidar and S. Soimakallio
American Journal of Neuroradiology January 2013, 34 (1) 100-106; DOI: https://doi.org/10.3174/ajnr.A3149
N. Sillanpää
aFrom the Medical Imaging Center (N.S., P.D., S.S.), Tampere University Hospital, Tampere, Finland
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J.T. Saarinen
bDepartment of Neurology (J.T.S., I.E.), School of Medicine, University of Tampere, Tampere, Finland
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H. Rusanen
cDepartment of Neurology (H.R.), Oulu University Hospital, Oulu, Finland.
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I. Elovaara
bDepartment of Neurology (J.T.S., I.E.), School of Medicine, University of Tampere, Tampere, Finland
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P. Dastidar
aFrom the Medical Imaging Center (N.S., P.D., S.S.), Tampere University Hospital, Tampere, Finland
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S. Soimakallio
aFrom the Medical Imaging Center (N.S., P.D., S.S.), Tampere University Hospital, Tampere, Finland
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Abstract

BACKGROUND AND PURPOSE: The location of the clot is a major determinant of ischemic stroke outcome. We studied the impact of the location (ICA, proximal M1 segment of the MCA, distal M1 segment, and M2 segment and more distally) of the clot on the CT perfusion parametric maps, the mismatch ratio, the amount of salvaged brain tissue, and the imaging and clinical outcomes in a retrospective acute (<3 hours) stroke cohort treated with intravenous thrombolysis.

MATERIALS AND METHODS: We reviewed 105 patients who underwent admission multimodal CT that revealed an occluded vessel on CTA. CT perfusion was successfully performed in 58 patients (55%). Differences among the parameters in different vessel positions were studied with the ANCOVA by using onset-to-imaging time as a covariate followed by pair-wise testing.

RESULTS: There were no significant differences in potential confounding variables among the groups. A clot proximal to the M2 segment produced a significantly larger defect on the MTT map. A clot in the ICA resulted in a significantly larger CBV lesion compared with the distal M1 segment, the M2 segment, and the M3 segment. In general, a more proximal thrombus created a larger CBV defect. The fraction of penumbra that was salvaged at 24 hours was higher in the more distal vessel positions.

CONCLUSIONS: Admission CBV defects are larger in proximal vessel occlusions. More of the penumbra can be salvaged if the occlusion is located distally. This effect seems to reach a plateau in the distal M1 segment of the MCA.

ABBREVIATIONS:

ANCOVA
analysis of covariance
ASPECTS
Alberta Stroke Program Early CT Score
CBS
clot-burden score
ICC
intraclass correlation coefficient
mRS
modified Rankin Scale
  • © 2013 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 34 (1)
American Journal of Neuroradiology
Vol. 34, Issue 1
1 Jan 2013
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Cite this article
N. Sillanpää, J.T. Saarinen, H. Rusanen, I. Elovaara, P. Dastidar, S. Soimakallio
Location of the Clot and Outcome of Perfusion Defects in Acute Anterior Circulation Stroke Treated with Intravenous Thrombolysis
American Journal of Neuroradiology Jan 2013, 34 (1) 100-106; DOI: 10.3174/ajnr.A3149

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Location of the Clot and Outcome of Perfusion Defects in Acute Anterior Circulation Stroke Treated with Intravenous Thrombolysis
N. Sillanpää, J.T. Saarinen, H. Rusanen, I. Elovaara, P. Dastidar, S. Soimakallio
American Journal of Neuroradiology Jan 2013, 34 (1) 100-106; DOI: 10.3174/ajnr.A3149
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Cited By...

  • Location-Specific ASPECTS Paradigm in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
  • Impact of Collateral Status Evaluated by Dynamic Computed Tomographic Angiography on Clinical Outcome in Patients With Ischemic Stroke
  • Contribution and Additional Impact of Imaging to the SPAN-100 Score
  • Collateral Score Complements Clot Location in Predicting the Outcome of Intravenous Thrombolysis
  • Computed Tomography Angiography in Hyperacute Ischemic Stroke: Prognostic Implications and Role in Decision-Making
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More in this TOC Section

  • Multimodal CT Provides Improved Performance for Lacunar Infarct Detection
  • Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA?
  • Evaluating the Effects of White Matter Multiple Sclerosis Lesions on the Volume Estimation of 6 Brain Tissue Segmentation Methods
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