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Posterior cerebral artery laterality on magnetic resonance angiography predicts long-term functional outcome in middle cerebral artery occlusion.

AbstractBACKGROUND AND PURPOSE:
Prominent posterior cerebral artery (PCA) laterality upon 3-dimensional time-of-flight magnetic resonance angiography is often encountered in patients with middle cerebral artery occlusion. We hypothesized that this sign is correlated with improved functional outcome in patients with middle cerebral artery occlusion treated with intravenous recombinant tissue plasminogen activator.
METHODS:
Fifty acute ischemic stroke patients with middle cerebral artery occlusion were treated with intravenous recombinant tissue plasminogen activator from April 2007 to October 2009. All patients routinely underwent initial (first 3 hours) magnetic resonance scans on admission, and additional follow-up (14-21 days after stroke onset) computed tomography scans. Two film readers blinded to all clinical information assessed the presence or absence of PCA laterality on magnetic resonance angiography. We retrospectively analyzed the clinical and radiologic data on all patients.
RESULTS:
Out of 50 patients, 20 showed PCA laterality on magnetic resonance angiography. National Institute of Health Stroke Scale score 7 days after stroke onset was significantly lower (P=0.007), and infarct volume on follow-up computed tomography was significantly smaller (P=0.009) in patients with PCA laterality than in patients without this sign. Multivariate logistic regression analyses showed an adjusted odds ratio of 8.49 for a favorable outcome (modified Rankin Scale score 0-1 at 6 months) in patients with PCA laterality (95% CI: 1.82 to 55.8, P=0.005).
CONCLUSIONS:
The presence of PCA laterality on magnetic resonance angiography before intravenous recombinant tissue plasminogen activator can be used as a predictor of favorable functional outcome in patients with middle cerebral artery occlusion, probably due to improvement of recanalization rate.
AuthorsMasahiko Ichijo, Kazunori Miki, Satoru Ishibashi, Makoto Tomita, Tomoyuki Kamata, Hiroto Fujigasaki, Hidehiro Mizusawa
JournalStroke (Stroke) Vol. 44 Issue 2 Pg. 512-5 (Feb 2013) ISSN: 1524-4628 [Electronic] United States
PMID23192760 (Publication Type: Journal Article)
Chemical References
  • Tissue Plasminogen Activator
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Infarction, Middle Cerebral Artery (diagnosis, drug therapy, physiopathology)
  • Magnetic Resonance Angiography (methods)
  • Male
  • Middle Aged
  • Posterior Cerebral Artery (pathology)
  • Predictive Value of Tests
  • Recovery of Function (physiology)
  • Retrospective Studies
  • Single-Blind Method
  • Time Factors
  • Tissue Plasminogen Activator (therapeutic use)
  • Treatment Outcome

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