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Stroke- on- Awakening: Safety of CT-CTA Based Selection for Reperfusion Therapy

Published online by Cambridge University Press:  23 September 2014

Simerpreet Bal ,
Rohit Bhatia ,
Nandavar Shobha ,
Bijoy K. Menon ,
Sung Il Sohn ,
Mayank Goyal ,
Andrew M. Demchuk ,
Michael D. Hill  and
for the Calgary CTA group
Simerpreet Bal
Affiliation:
Section of Neurology, Faculty of Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba
Rohit Bhatia
Affiliation:
All India Institute of Medical Sciences, New Delhi, India
Nandavar Shobha
Affiliation:
Bangalore Neuro Centre, Vagus Superspecialty Hospital, Bhagwan Mahaveer Jain Hospital, Vikram Hospital, Bangalore, India
Bijoy K. Menon
Affiliation:
Calgary Stroke program, Department of Clinical neuroscienes, department of radiology, hotchkiss Brain institute, faculty of Medicine, university of Calgary, Calgary, alberta, Canada
Sung Il Sohn
Affiliation:
Department of Neurology, Dongsan Medical Centre, Keimyung University School of Medicine, Daegu, South Korea
Mayank Goyal
Affiliation:
Calgary Stroke program, Department of Clinical neuroscienes, department of radiology, hotchkiss Brain institute, faculty of Medicine, university of Calgary, Calgary, alberta, Canada
Andrew M. Demchuk
Affiliation:
Calgary Stroke program, Department of Clinical neuroscienes, department of radiology, hotchkiss Brain institute, faculty of Medicine, university of Calgary, Calgary, alberta, Canada
Michael D. Hill*
Affiliation:
Calgary Stroke program, Department of Clinical neuroscienes, department of radiology, hotchkiss Brain institute, faculty of Medicine, university of Calgary, Calgary, alberta, Canada
*
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, RM 1242A, 1403 29th Street NW, Calgary, alberta, T2N 2T9, Canada. Email: michael.hill@ucalgary.ca
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Abstract

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Background:

We studied the safety of use of acute reperfusion therapies in patients with stroke- on- awakening using a computed tomographic angiography (Cta) based large vessel occlusion-good scan paradigm in clinical routine.

Methods:

the Cta database of the Calgary stroke program was reviewed for the period January 2003-March 2010. patients with stroke-on-awakening with large artery occlusions on Cta, who received conservative, iV thrombolytic and/or endovascular treatment at discretion of the attending stroke neurologist were analyzed. time of onset was defined by the time last seen or known to be normal. Baseline non-contrast Ct scan (nCCt) alberta Stroke program early Ct Score (aSpeCtS) > 7 was considered a good scan. hemorrhage was defined on follow-up brain imaging using eCaSS 3 criteria. independence (mrS≤2) at three months was considered a good clinical outcome. Standard descriptive statistics and multivariable analysis were done.

Results:

among 532 patients with large artery occlusions, 70 patients with stroke-on-awakening (13.1%) were identified. the median age was 69.5 (iQr 24) and 41 (58.6%) were female; 41 (58.6%) received anti-platelets only and 29 (41.4%) received thrombolytic treatment [iV-12 (17.1%), iV/ia-12 (17.1%) and ia-5(7.1%)]. unadjusted analysis showed that baseline nCCt aSpeCtS ≤ 7 (p=0.002) and higher nihSS scores (p=0.018) were associated with worse outcomes. there were no ph2 hemorrhages in the iV thrombolytic or endovascular treated group. functional outcome was not different by treatment.

Conclusion:

When carefully selected using Ct –Cta, by a good scan (aSpeCtS > 7) occlusion paradigm, acute reperfusion therapies in patients with stroke-on-awakening can be performed safely in clinical routine.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 2 , March 2014 , pp. 182 - 186
Copyright
Copyright © The Canadian Journal of Neurological 2014

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