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Serial changes in ischemic lesion volume and neurological recovery after t-PA therapy

Kazumi Kimura1, Yuki Sakamoto, Yasuyuki Iguchi

  • 1Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan. kimurak@med.kawasaki-m.ac.jp

Journal of the Neurological Sciences
|March 15, 2011
PubMed
Abstract

Insights

Serial changes in ischemic lesion volume (ILV) predict neurological recovery after t-PA therapy. Specific thresholds of ILV enlargement indicate remarkable or good recovery in stroke patients.

Area of Science:

  • Neuroscience
  • Radiology
  • Stroke Medicine

Background:

  • Ischemic stroke treatment with tissue plasminogen activator (t-PA) is time-sensitive.
  • Monitoring lesion evolution is crucial for predicting patient outcomes.

Purpose of the Study:

  • To investigate the relationship between serial changes in ischemic lesion volume (ILV) and neurological recovery.
  • To establish predictive thresholds for recovery based on ILV changes after t-PA therapy.

Main Methods:

  • Prospective study of 110 patients with ICA/MCA occlusion treated with t-PA within 3 hours.
  • Serial MRI (MRA, DWI, FLAIR) performed at baseline, 1h, 24h, and 7 days post-t-PA to measure ILV.
  • Correlation analysis between changes in ILV (ΔILV) and neurological recovery (NIHSS score change).

Main Results:

  • Mean ILV increased from 30.2 cm³ at baseline to 125.9 cm³ at 7 days.
  • ΔILV correlated significantly with neurological recovery (r=0.611, P<0.0001).
  • A ΔILV of 40 cm³ predicted remarkable recovery (80.0% sensitivity, 79.3% specificity), and 80 cm³ predicted good recovery (78.8% sensitivity, 76.3% specificity).

Conclusions:

  • Serial ILV changes are valuable predictors of neurological recovery post-t-PA.
  • Established ΔILV thresholds of 40 cm³ and 80 cm³ can predict remarkable and good recovery, respectively.

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