• Stroke · Apr 2004

    Clinical Trial

    Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke.

    • Woong Yoon, Jeong Jin Seo, Jae Kyu Kim, Ki Hyeon Cho, Jin Gyoon Park, and Heoung Keun Kang.
    • Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 8 Hak-1-Dong, Dong-gu, Gwangju, 501-757, South Korea. radyoon@cnuh.com
    • Stroke. 2004 Apr 1; 35 (4): 876-81.

    Background And PurposeThe goal of this study was to determine the CT findings and clinical consequences of contrast enhancement and contrast extravasation on CT scans obtained after intra-arterial thrombolytic therapy for treatment of acute ischemic stroke.MethodsSixty-two patients were treated with intra-arterial thrombolysis. All patients underwent nonenhanced CT scans immediately and 24 hours after thrombolytic therapy. Contrast enhancement was defined as a hyperdense lesion that disappeared on a 24-hour follow-up CT scan. Contrast extravasation was defined as a hyperdense lesion with maximum Hounsfield unit >90 that persisted on a follow-up CT scan. We evaluated the differences in the clinical and radiological data between 3 groups: contrast enhancement, contrast extravasation, and control groups.ResultsContrast enhancement was found in 14 of 62 patients (22.6%); contrast extravasation was seen in 7 (11.3%). Compared with the control group, the contrast enhancement group had a lower recanalization grade (64.3% versus 34.1%, P=0.048) and a lower incidence of hemorrhagic transformation (14.3% versus 43.9%, P=0.047). The contrast extravasation group had a higher incidence of both hemorrhage (100% versus 43.9%, P=0.006) and symptomatic hemorrhage (100% versus 14.6%, P<0.001) than the control group. Poor outcomes were more frequent in the contrast extravasation group (100% versus 38.9%, P=0.003) than the control group.ConclusionsContrast enhancement on CT scans obtained after intra-arterial thrombolysis is usually not associated with hemorrhagic complications. However, contrast extravasation is highly associated with parenchymatous hematoma and should be considered a negative prognostic sign.

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