AI Article Synopsis
- Endovascular therapy (EVT) combined with intravenous thrombolysis is the standard treatment for strokes caused by large-vessel occlusion (LVO), but primary stroke centers without EVT capabilities must recognize patients needing further treatment.
- Carotid ultrasonography (CUS) is a simple bedside method that can help identify patients with residual LVO after initial thrombolysis, potentially allowing for timely transport to specialized facilities.
- The study found that certain clinical indicators, such as a high NIHSS score and specific imaging signs, can predict the presence of residual LVO with 100% sensitivity, suggesting that integrating CUS in assessments can improve patient outcomes.
Article Abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
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