الفهرس 
STROKEOnly 14 pages are availabe for public view
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Abstract
S
troke is a major global health problem with an estimated incidence rate of around 15 million new cases each year worldwide. Stroke is a leading cause of fatality and long-term disability. It is currently the third leading cause of death preceded only by heart disease and cancers. Fatality rate increases progressively in the post-ischemic stroke period with an estimated rate of 33% and 80% fatalities in the first year and 10 years, respectively.
When various periods of temporary or permanent ischemia were compared, behavioral deficits were capable of reversal following 30 min to 4 hours of ischemia but were rarely reversible after 8 hours. Presciently, the variability and reversibility of focal ischemia were likely related to differences in the availability of collateral circulation and the manner in which local perfusion is regulated in still-patent vessels.
The relevance of the collateral circulation was reinforced by computed tomographic- (CT-) and angiography-based studies in patients with supratentorial infarction, which revealed that hypodense areas on CT (signifying evolving infarction) were always smaller than angiographically abnormal regions when early recanalization occurred, and that prognosis was improved by early recanalization or the presence of collateral circulation.
Patients and methods:
The study was carried out in the inpatient department of neurology department at Ain Shams University Hospitals.
A convenience sample of 30 patients with acute ischemic stroke.
The sample was collected according to the inclusion and exclusion criteria.
The patients were assessed using the following measures:
CT cerebral angiography was done to assess the clot burden score and collateral score.
MRI stroke protocol was done for patients to assess the structural collaterals through diffusion weigheted image, FLAIR, NIH, and MRS.
Results:
Patient’s mean age was 56-58 years, 70% were males, more than half of patients were diabetic, hypertensive, smoker, and positively for dyslipidemia.
Majority of patients who received rtPA have a negative history of stroke or transient ischemic attack.
There was a statistical significant difference between stroke patients who received treatment and patients who didn’t receive in relation to collateral score, clotting burden score, modified rankin scale after three months, onset by hours and door to needle.
Assessment through the National Institute of Health stroke score shows that patients who received treatment have a higher level of change on admission and after one week than patients who didn’t receive treatment.
Computed tomography angiography and MRA play an important role in assessment of the collateral blood vessels, clot burden score, infract volume and predict the need for rtPA and degree of improvement.
There was a significant correlation between modified rankin scale and clotting burden scale, collateral scale and infract volume
Patient with good NIH score and MRS shows a higher level of improvement and change.
Patient’s sex, DM, hypertension and stroke site determine and affect the value of clot burden score.
Conclusion:
The results of the present study shows that risk for cerebrovascular ischemic stroke is increased by age, male sex, presence of diabetes, hypertension, smoking, and dyslipidemia.
Past history of stroke or transient ischemic attack plays an important role in the effect of recumbent tissue plasminogen activator.
There was a statistical significant difference between stroke patients who received treatment and patients who didn’t receive in relation to collateral score, clotting burden score, modified rankin scale after three months, onset by hours and door to needle.
Assessment through the National Institute of Health stroke score shows that patients who received treatment have a higher level of change on admission and after one week than patients who didn’t receive treatment.
Computed tomography angiography and MRA play an important role in assessment of the collateral blood vessels, clot burden score, infract volume and predict the need for rtPA and degree of improvement.
There was a significant correlation between modified rankin scale and clotting burden scale, collateral scale and infract volume
Patient with good NIH score and MRS shows a higher level of improvement and change.
Patient’s sex, DM, hypertension and stroke site determine and affect the value of clot burden score.
Patients with good collateral status benefit from recanalization; patients with poor collaterals do not benefit even when recanalization.
Recommendations
Due to recent administration of rtPA small sample size of our study it was not feasible to evaluate statistical difference between all subgroups. Conducting a study with larger sample size can yield better and more precise results.
Assessment of factors that negatively influence the collateral blood vessels and disrupt the value of rtPA.
Testing the utility of multi-phase CTA in helping physicians select the right patient for endovascular therapy.
Assessment of the genetic determinants of collateral status.
Study the patients’ satisfaction level and cost effectiveness after administration of rtPA.