1. University of Bologna, Italy Chair of Neuroradiology
Prof. Marco Leonardi
University of Bologna, Italy
Chair of Neuroradiology
Bellaria Hospital
Dr Luigi Simonetti

2. Relation between Site of Occlusion and Outcome of Intravenous
Thrombolysis in a Cohort of Patients Studied with CT Angiography
C. Barbara, A. Stafa, G. Procaccianti, L. Simonetti, M. Leonardi

3. From the beginning…
Few slides about our “modus operandi” in acute stroke.

4. Intra-hospital Step
When a patient is considered to be eligible for the trombolitic treatment, the dedicated “trombolysis team” will be alerted with “Stroke Yellow Code”

5. The principal inclusion criteria for the trombolysis:
Both sex patients, age range years
Ischemic stroke generating an acute neurological deficit
Starting symptoms: < 3 hours
Brain CT excluding intracranial haemorrhage
ASPECT Score: > 7

6. When we perform CTA of supra-aortic vessels & intracranial circulation?
Always, if the patient is eligible for IV or IA trombolysis

8. TROMBOLYSIS: april 2008-september 2010

10. - 240 pts (ab 50%) excluded during ER evaluation, before CT scan
starting symptoms: >3h before, or time not definable (stroke presumably in asleep patient): 54
Age >
mild neurological deficit 51
TIA
deep coma
dismetabolic coexisting diseas 20
epileptic seizures
psychiatrical clinical back-ground
other

12. - 95 pts (20%) excluded after CT-CTA scan
intracranial hemorrhage 67
extracranial ICA occlusion
ASPECT score <
10 pts (their relatives) refused therapy

13. Overall Results
Δ NIHSS 24 h: 5.0

14. T-shaped occlusion (15 pts)
Δ NIHSS 24 h : -2

15. BM, 33 aa Left Hemiparesis

19. M1 occlusion (31 pts)
Δ NIHSS 24 h: 3.9

20. “Mild” M1 occlusion

21. CR, F 58 aa Left hemiplegia 190’ aftert presuming start od symptoms
CR, F 58 aa Left hemiplegia 190’ aftert presuming start od symptoms. IV rTPA

25. “Severe” M1 occlusion

26. BMP, 59 aa right hemiplegia 3h 20’ after presuming start of symptoms

31. Δ NIHSS 24 h: 9

33. M2 occlusion (39 pts)
Δ NIHSS 24 h: 6.2

34. TL, 68 aa Left hemiplegia 3h 40’after presuming start of symptoms, IV rTPA

40. Distal branch occlusion (53 pts)
Δ NIHSS 24 h: 6.5

41. TM, 62 aa Right hemiparesis and afasia

42. Admission brain CT

43. Admission CTA

44. 36 h CT

48. TROMBOLYSIS H. Maggiore April 2008 – september 2010 Overall Outcome on 138 pts:
Rankin Scale % 32
1-2 26 3 5
4-5 33 6 4
TOTAL
100

49. On the base of these CTA data
In accord (+/-) with our neurologists

50. Three protocols that our Ethical Committee approved on July 2010
Pts with “mild” M1 occlusion: Synthesis Expansion randomization
Pts with M2 or distal occlusion: IV, eventually ”bridging therapy”
Pts with “T shaped” occlusion or “severe” occlusion in M1: “Opus” experimental study (intra-arterial thrombolysis by UV laser)

51. Some conclusive considerations
The role of the diagnostical and therapeutical neuroradiology is fully recognized and formalized
The intra-venous trombolysis? It works.
The CT-Angio, performed in every case as a standard step of the protocol, represents an important tool for the definition of the prognosis and, potentially, for the definition of the therapeutical choice.

52. Thank you for the kind attention