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Use of intravenous(IV) thrombolysis and intra-arterial(IA) recanalization treatment has been rapidly increasing, However, despite of the treatment, recanalization rates are 22.6 - 70% and only 30-50% of patients show meaningful clinical improvements. Mechanisms of futile recanalization may include 1) large ischemic core, 2) poor collateral, and 3) presence of comorbidity. In this regards, developing selection criteria using acute stroke imaging and comorbidity is warranted.
The investigators will recruit the consecutive acute stroke patients who received IV thrombolysis and/or IA recanalization treatment. This study will perform with prospective design to develop CT-based clot, core and collateral scores and a comorbidity index for selecting stroke patients who are at high risks by the treatment. The investigators will firstly establish the CT-based scores and comorbidity index using a pre-existing cohort database. Using these CT-based and comorbidity index, the investigators will validate them in a multi-center prospectively cohort.
1)Full design
2) retrospective design
3) prospective design
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Acute ischemic stroke patients | Acute ischemic stroke patients who received intravenous (IV) thrombolysis and/or intra-arterial (IA) recanalization treatment |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Brain CT imaging | Other | The investigators will analyzed the CT image that was performed in patients with hyperacute stroke. The CT protocol includes CT thrombus, collateral, core images. The investigators also obtain detailed history and laboratory and imaging result for comorbidity. The comorbidity index protocol is based on the Charlson comorbidity index.
|
| Measure | Description | Time Frame |
|---|---|---|
| Modified Rankin scale scores | Functional improvement after stroke at 3 months Scale range: 0(Best)~6(Worst) , Functional outcome measure in stroke. Levels of disability 0: No symptoms at all
| at 3 months |
| Any death | Any death within 6 months | within 6 months |
| National Institutes of Health Stroke Scale (NIHSS) scores | Primary Outcome Description: Neurological improvement according to NIHSS scores National Institutes of Health Stroke Scale (NIHSS) scores The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0. (total score : 0(good)~ 42(death)) | at 1 day |
| Recanalization rate | Recanalization rate after thrombolytic treatments in MRA, CTA, or digital subtraction angiography (DSA) at 24 hours ± 8 hours | at 24 hours ± 8 hours |
| Asymptomatic hemorrhagic transformation rate |
| Measure | Description | Time Frame |
|---|---|---|
| Causes of deaths | Causes of deaths after thrombolytic treatments within 6 month | within 6 month |
| Stroke subtypes | The Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification |
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Inclusion Criteria:
Exclusion Criteria:
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Acute ischemic stroke patients who received intravenous (IV) thrombolysis and/or intra-arterial (IA) recanalization treatment
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Neurology, Yonsei University College of Medicine | Seoul | South Korea |
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| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| D020521 | Stroke |
| D013927 | Thrombosis |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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whole blood, frozen tissue
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Hemorrhagic transformation rate after thrombolysis in MR or CT at 24 hours ± 8 hours |
| at 24 hours ± 8 hours |
| Any complication rate including extracranial life-threatening bleeding, herniation, infection rate | Any complication rate including extracranial life-threatening bleeding, herniation, infection rate within 7 days | within 7 days |
| within 7 days |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D016769 | Embolism and Thrombosis |