ArticleBrain circulation
Cerebral arterial collateral status, but not venous outflow profiles, modifies the effect of intravenous tissue plasminogen activator in acute ischemic stroke.
Article in Brain circulation. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Optimizing Early Antithrombotic Therapy Within 24 Hours of Intravenous Thrombolysis in Acute Ischemic Stroke.CNS drugs · 2026Review
- Diversity of Brain Microvascular Endothelial Cell Functions: Physiology, Ischemia/Hypoxia, and Underlying Protection.Aging and disease · 2025Review
- Interaction between Brain Natriuretic Peptide and QTc Prolongation on Mortality in Patients with Stroke-Heart Syndrome.Aging and disease · 2025Article
- Therapeutic potential of natural products in ischemic stroke: targeting angiogenesis.Frontiers in pharmacology · 2025Review
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe role of arterial collateral and venous outflow status on the response to intravenous tissue plasminogen activator (IV-tPA) has not been sufficiently clarified in acute major cerebral occlusions. PATIENTS AND
methodsA total of 130 patients (mean age: 71 years; 73 females) with acute middle cerebral artery M1/M2 segment or terminal internal carotid artery occlusion treated solely with IV-tPA were analyzed. Regional leptomeningeal score (rLMC) was used for cerebral arterial collateral scoring, and the cortical vein opacification score (COVES) and modified Prognostic Evaluation based on Cortical vein score difference In Stroke (PRECISE) superficial and deep scores were used for venous outflow profile. Exploratory logistic models for response to IV-tPA [positive response: National Institutes of Health Stroke Scale (NIHSS) decrease 4 (or decrease to 0) at 24 h; dramatic response: NIHSS decrease ≥8 (or decrease to 0 or 1)], functional outcome (modified Rankin's score 0-1 as "excellent" and 0-2 "good") and tPA-associated hemorrhagic transformation were constructed.
resultsIV-tPA efficacy was positive in 47% and dramatic in 32%. Dramatic response was linked to better arterial collateral status (exp[B] =1.115 [95% confidence interval (CI), 1.016-1.223]). Excellent outcome was noted in 26% and good in 45%. One-point increase in rLMC score independently increased good prognosis (exp[B] =1.209 [1.034-1.412]). Patients with good prognosis had higher (by 0.5 points) modified PRECISE deep score (
conclusionWhile arterial collateral status modifies the effect of tPA in acute anterior circulation major artery occlusions, venous outflow capacity is not so critical.
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