American Journal of Neuroradiology, Vol 19, Issue 5 839-846, Copyright © 1998 by American Society of Neuroradiology
ARTICLES |
The predictive value of early CT and angiography for fatal hemispheric swelling in acute stroke
T Kucinski, C Koch, U Grzyska, HJ Freitag, H Kromer and H Zeumer
Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany.
PURPOSE: Our goal was to analyze the predictive value of early CT and arteriographic morphologic criteria to achieve a more reliable prediction of fatal outcome in patients undergoing fibrinolytic stroke treatment. METHODS: In 74 patients with acute carotid artery stroke, early signs of cerebral ischemia were determined by CT. The site of vascular occlusion was identified by digital subtraction angiography (DSA). The patients were subsequently treated by intraarterial (n = 68) or intravenous (n = 6) fibrinolysis by means of recombinant tissue plasminogen activator (rt-PA), urokinase, or rt-PA combined with lys- plasminogen and followed-up for a period of 3 months. CT and DSA data were compared with the clinical course, with special emphasis on signs of early fatal deterioration (ie, death by intracranial mass effect) as determined by corresponding CT and clinical observations, occurring within 7 days after stroke. RESULTS: Seventeen patients died, all of intracranial mass effect, and all within a week after stroke. In nine of these fatalities, DSA revealed carotid "T" occlusion (CTO), which affected 19 patients. In five of the fatalities, a major early sign of ischemia (MESI, referring to cortical hypodensity in more than a third of the territory of the middle cerebral artery, as seen in 14 patients) was recognizable on the initial CT scan. This led to a higher predictive value and sensitivity of CTO relative to MESI for estimating early fatality. CONCLUSION: CTO as determined by DSA is a substantially better predictor of fatal outcome in patients undergoing intraarterial thrombolytic therapy than is MESI as determined by CT.
This article has been cited by other articles:
 |
|
 |
|
  J. A. Alawneh, R. R. Moustafa, and J.-C. Baron Hemodynamic Factors and Perfusion Abnormalities in Early Neurological Deterioration Stroke, June 1, 2009; 40(6): e443 - e450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Favrole, J P Saint-Maurice, M G Bousser, and E Houdart Use of mechanical extraction devices in basilar artery occlusion J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1462 - 1464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Fiehler, K. Knudsen, G. Thomalla, E. Goebell, M. Rosenkranz, C. Weiller, J. Rother, H. Zeumer, and T. Kucinski Vascular Occlusion Sites Determine Differences in Lesion Growth from Early Apparent Diffusion Coefficient Lesion to Final Infarct AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1056 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Wardlaw and O. Mielke Early Signs of Brain Infarction at CT: Observer Reliability and Outcome after Thrombolytic Treatment--Systematic Review Radiology, May 1, 2005; 235(2): 444 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kucinski, D. Naumann, R. Knab, V. Schoder, S. Wegener, J. Fiehler, A. Majumder, J. Rother, and H. Zeumer Tissue at Risk Is Overestimated in Perfusion-Weighted Imaging: MR Imaging in Acute Stroke Patients without Vessel Recanalization AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 815 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, T. Kucinski, K. Knudsen, M. Rosenkranz, G. Thomalla, C. Weiller, J. Rother, and H. Zeumer Are There Time-Dependent Differences in Diffusion and Perfusion Within the First 6 Hours After Stroke Onset? Stroke, September 1, 2004; 35(9): 2099 - 2104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, K. Knudsen, T. Kucinski, C. S. Kidwell, J. R. Alger, G. Thomalla, B. Eckert, O. Wittkugel, C. Weiller, H. Zeumer, et al. Predictors of Apparent Diffusion Coefficient Normalization in Stroke Patients Stroke, February 1, 2004; 35(2): 514 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Leary, C. S. Kidwell, J. P. Villablanca, S. Starkman, R. Jahan, G. R. Duckwiler, Y. P. Gobin, S. Sykes, K. J. Gough, K. Ferguson, et al. Validation of Computed Tomographic Middle Cerebral Artery """Dot""" Sign: An Angiographic Correlation Study Stroke, November 1, 2003; 34(11): 2636 - 2640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Thomalla, T. Kucinski, V. Schoder, J. Fiehler, R. Knab, H. Zeumer, C. Weiller, and J. Rother Prediction of Malignant Middle Cerebral Artery Infarction by Early Perfusion- and Diffusion-Weighted Magnetic Resonance Imaging Stroke, August 1, 2003; 34(8): 1892 - 1899. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Arnold, K Nedeltchev, H P Mattle, T J Loher, F Stepper, G Schroth, C Brekenfeld, M Sturzenegger, and L Remonda Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions J. Neurol. Neurosurg. Psychiatry, June 1, 2003; 74(6): 739 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Koga, Y Saku, K Toyoda, H Takaba, S Ibayashi, and M Iida Reappraisal of early CT signs to predict the arterial occlusion site in acute embolic stroke J. Neurol. Neurosurg. Psychiatry, May 1, 2003; 74(5): 649 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Manno, D. A. Nichols, J. R. Fulgham, and E. F. M. Wijdicks Computed Tomographic Determinants of Neurologic Deterioration in Patients With Large Middle Cerebral Artery Infarctions Mayo Clin. Proc., February 1, 2003; 78(2): 156 - 160. [Abstract] [PDF]
|
|
|
|
|
|
A. A. Rabinstein, E. F. M. Wijdicks, and D. A. Nichols Complete Recovery after Early Intraarterial Recombinant Tissue Plasminogen Activator Thrombolysis of Carotid T Occlusion AJNR Am. J. Neuroradiol., October 1, 2002; 23(9): 1596 - 1599. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, M. von Bezold, T. Kucinski, R. Knab, B. Eckert, O. Wittkugel, H. Zeumer, and J. Rother Cerebral Blood Flow Predicts Lesion Growth in Acute Stroke Patients Stroke, October 1, 2002; 33(10): 2421 - 2425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Rother, P.D. Schellinger, A. Gass, M. Siebler, A. Villringer, J.B. Fiebach, J. Fiehler, O. Jansen, T. Kucinski, V. Schoder, et al. Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke <6 Hours Stroke, October 1, 2002; 33(10): 2438 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kucinski, O. Vaterlein, V. Glauche, J. Fiehler, E. Klotz, B. Eckert, C. Koch, J. Rother, and H. Zeumer Correlation of Apparent Diffusion Coefficient and Computed Tomography Density in Acute Ischemic Stroke Stroke, July 1, 2002; 33(7): 1786 - 1791. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kasner, A. M. Demchuk, J. Berrouschot, E. Schmutzhard, L. Harms, P. Verro, J. A. Chalela, R. Abbur, H. McGrade, I. Christou, et al. Predictors of Fatal Brain Edema in Massive Hemispheric Ischemic Stroke Stroke, September 1, 2001; 32(9): 2117 - 2123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Keris, S. Rudnicka, V. Vorona, G. Enina, B. Tilgale, and J. Fricbergs Combined Intraarterial/Intravenous Thrombolysis for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 352 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Gerriets, E. Stolz, S. Konig, S. Babacan, I. Fiss, M. Jauss, and M. Kaps Sonographic Monitoring of Midline Shift in Space-Occupying Stroke : An Early Outcome Predictor Stroke, February 1, 2001; 32(2): 442 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Oppenheim, Y. Samson, R. Manai, T. Lalam, X. Vandamme, S. Crozier, A. Srour, P. Cornu, D. Dormont, G. Rancurel, et al. Prediction of Malignant Middle Cerebral Artery Infarction by Diffusion-Weighted Imaging Stroke, September 1, 2000; 31(9): 2175 - 2181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Reichenbach, J. Röther, L. Jonetz-Mentzel, M. Herzau, A. Fiala, C. Weiller, and W. A. Kaiser Acute Stroke Evaluated by Time-to-Peak Mapping during Initial and Early Follow-up Perfusion CT Studies AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1842 - 1850. [Abstract] [Full Text]
|
|
|
|
|
|
R. Jahan, G. R. Duckwiler, C. S. Kidwell, J. W. Sayre, Y. P. Gobin, J. PabloVillablanca, J. Saver, S. Starkman, N. Martin, and F. Vinuela Intraarterial Thrombolysis for Treatment ofAcute Stroke: Experience in 26 Patients withLong-Term Follow-up AJNR Am. J. Neuroradiol., August 1, 1999; 20(7): 1291 - 1299. [Abstract] [Full Text]
|
|
|
|
|
|
Skutta, Fürst, Eilers, Ferbert, and Kuhn Intracranial Stenoocclusive Disease: Double-Detector Helical CT Angiography versus Digital Subtraction AJNR Am. J. Neuroradiol., May 1, 1999; 20(5): 791 - 799. [Abstract] [Full Text]
|
|
|
|
|
|
D. W. Krieger, A. M. Demchuk, S. E. Kasner, M. Jauss, and L. Hantson Early Clinical and Radiological Predictors of Fatal Brain Swelling in Ischemic Stroke Stroke, February 1, 1999; 30(2): 287 - 292. [Abstract] [Full Text] [PDF]
|
|