Stroke- on- Awakening: Safety of CT-CTA Based Selection for Reperfusion Therapy
- Affiliated Author(s)
- 손성일
- Alternative Author(s)
- Sohn, Sung Il
- Journal Title
- Canadian Journal of Neurological Sciences
- ISSN
- 0317-1671
- Issued Date
- 2014
- Abstract
- 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.
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