Usefulness of carotid duplex ultrasonography in predicting residual large-vessel occlusions after intravenous recombinant tissue plasminogen activator therapy in patients with acute ischemic stroke.
Carotid duplex ultrasonography
End-diastolic ratio
Intravenous recombinant tissue plasminogen activator therapy
Large-vessel occlusions
Journal
Journal of medical ultrasonics (2001)
ISSN: 1613-2254
Titre abrégé: J Med Ultrason (2001)
Pays: Japan
ID NLM: 101128385
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
31
08
2022
accepted:
19
10
2022
pubmed:
4
12
2022
medline:
4
2
2023
entrez:
3
12
2022
Statut:
ppublish
Résumé
Endovascular therapy (EVT) preceded by intravenous thrombolysis with recombinant tissue plasminogen activator (iv-rtPA) has been established as a standard treatment in patients with stroke caused by large-vessel occlusion (LVO). Primary stroke centers without EVT competence need to identify patients with residual LVO after iv-rtPA therapy and transport them to an EVT-capable facility. Carotid ultrasonography (CUS) is easily applicable at bed side and useful for detecting extra- and intracranial LVO. This study aimed to determine whether CUS findings at admission are useful to predict patients with residual LVO after iv-rtPA. Patients scheduled to undergo iv-rtPA for acute cerebral infarction were registered. Before iv-rtPA, they underwent CUS, followed by CTA or MRA evaluation within 6 h after iv-rtPA. A model that can achieve 100% sensitivity for detecting residual LVO after iv-rtPA was studied. This study included 68 of 116 patients treated with iv-rtPA during the study period. National Institutes of Health Stroke Scale (NIHSS) score (cutoff value = 10) on arrival, hyperdense MCA sign on non-contrast CT, end-diastolic (ED) ratio on CUS, and eye deviation were significantly different between patients with residual LVO after iv-rtPA and those without. If any of these clinical features are positive in the screening test, residual LVO could be predicted with 100% sensitivity, 50% specificity, 64% positive predictive value, and 100% negative predictive value. Prediction of residual LVO with 100% sensitivity may be feasible by adding CUS to NIHSS score > 10, the presence of eye deviation, and hyperdense MCA sign.
Identifiants
pubmed: 36463366
doi: 10.1007/s10396-022-01271-x
pii: 10.1007/s10396-022-01271-x
doi:
Substances chimiques
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-109Subventions
Organisme : Practical Research Project for Rare/Intractable Diseases of the Japan Agency for Medical Research and Development
ID : JP22ek0109529h
Organisme : Practical Research Project for Rare/Intractable Diseases of the Japan Agency for Medical Research and Development
ID : JP22ek0109441h
Organisme : Practical Research Project for Rare/Intractable Diseases of the Japan Agency for Medical Research and Development
ID : JP22ek0109493s
Organisme : Practical Research Project for Rare/Intractable Diseases of the Japan Agency for Medical Research and Development
ID : JP22ek0109548s
Organisme : Rare and Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan
ID : JPMH22FC1013
Organisme : Japan Society for the Promotion of Science (JSPS) KAKENHI
ID : JP22H02987
Informations de copyright
© 2022. The Author(s), under exclusive licence to The Japan Society of Ultrasonics in Medicine.
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