Neurology 1999;53:122
© 1999 American Academy of Neurology
Articles
Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery
A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)
H. P. Adams, Jr., MD,
B. H. Bendixen, PhD, MD,
E. Leira, MD,
K. C. Chang, MD,
P. H. Davis, MD,
R. F. Woolson, PhD,
W. R. Clarke, PhD and
M. D. Hansen, MS
From the Division of Cerebrovascular Diseases, Department of Neurology (Drs. Adams, Bendixen, Leira, Chang, and Davis) and the Division of Biostatistics, Department of Preventive Medicine (Drs. Woolson and Clarke, and M.D. Hansen), University of Iowa College of Medicine, Iowa City, IA.
Address correspondence and reprint requests to Dr. Harold P. Adams, Jr., Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: harold-adams{at}uiowa.edu
OBJECTIVE: To examine the responses to early IV administration of an anticoagulant or placebo started within 24 hours of stroke among persons with an ipsilateral occlusion or severe stenosis of the internal carotid artery (ICA) identified by carotid duplex imaging.
BACKGROUND: Patients with ischemic stroke of the cerebral hemisphere secondary to an ipsilateral occlusion or severe stenosis of the ICA generally have a poor prognosis. Early, accurate identification of these patients might permit improved treatment.
METHODS: Exploratory analysis of outcomes at 7 days and 3 months was performed among patients enrolled in the Trial of Org 10172 in Acute Stroke Treatment (TOAST) who had an ischemic stroke in the cerebral hemisphere ipsilateral to an occlusion or a stenosis >50% of the ICA identified by carotid duplex imaging.
RESULTS: Regardless of treatment, patients with duplex evidence of an occlusion of the ICA had more severe strokes and poorer outcomes at 7 days and 3 months than patients who had a stenosis. Favorable outcomes at 7 days were noted in 64 of 119 patients given danaparoid (53.8%) and 41 of 108 patients treated with placebo (38.0%; p = 0.023). By 3 months, favorable outcomes were noted in 82 patients given danaparoid (68.3%) and 58 patients administered placebo (53.2%; p = 0.021).
CONCLUSIONS: Early identification by duplex imaging of an occlusion or severe stenosis of the ICA ipsilateral to a hemispheric ischemic stroke might improve selection of patients who could be treated with emergent anticoagulation. Further testing of this approach is needed.
This article has been cited by other articles:
|
|
|
|
 
O. Ozdemir, M. Bussiere, A. Leung, I. Gulka, D. Lee, R. Chan, J.D. Spence, and D. Pelz
Intra-Arterial Thrombolysis of Occluded Middle Cerebral Artery by Use of Collateral Pathways in Patients with Tandem Cervical Carotid Artery/Middle Cerebral Artery Occlusion
AJNR Am. J. Neuroradiol.,
September 1, 2008;
29(8):
1596 - 1600.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D.C. Suh, J.K. Kim, C.G. Choi, S.J. Kim, H.W. Pyun, C. Ahn, D.H. Yang, K.S. Lim, J.-G. Leem, K.D. Hahm, et al.
Prognostic Factors for Neurologic Outcome after Endovascular Revascularization of Acute Symptomatic Occlusion of the Internal Carotid Artery
AJNR Am. J. Neuroradiol.,
June 1, 2007;
28(6):
1167 - 1171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Circulation,
May 22, 2007;
115(20):
e478 - e534.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Stroke,
May 1, 2007;
38(5):
1655 - 1711.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. G. Jovin, R. Gupta, K. Uchino, C. A. Jungreis, L. R. Wechsler, M. D. Hammer, A. Tayal, and M. B. Horowitz
Emergent Stenting of Extracranial Internal Carotid Artery Occlusion in Acute Stroke Has a High Revascularization Rate
Stroke,
November 1, 2005;
36(11):
2426 - 2430.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M.W. Bath, L. Zhao, and S. Heptinstall
Current status of stroke prevention in patients with atrial fibrillation
Eur. Heart J. Suppl.,
May 1, 2005;
7(suppl_C):
C12 - C18.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. S. Marshall, T. Rundek, D. M. Sproule, B.-F. M. Fitzsimmons, S. Schwartz, and R. M. Lazar
Monitoring of Cerebral Vasodilatory Capacity With Transcranial Doppler Carbon Dioxide Inhalation in Patients With Severe Carotid Artery Disease
Stroke,
April 1, 2003;
34(4):
945 - 949.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Broderick and W. Hacke
Treatment of Acute Ischemic Stroke: Part II: Neuroprotection and Medical Management
Circulation,
September 24, 2002;
106(13):
1736 - 1740.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. C. Meyer, T. M. Hemmen, C. M. Jackson, and P. D. Lyden
Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials: Prospective Reliability and Validity
Stroke,
May 1, 2002;
33(5):
1261 - 1266.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Ezzeddine, M. H. Lev, C. T. McDonald, G. Rordorf, J. Oliveira-Filho, F. G. Aksoy, J. Farkas, A. Z. Segal, L. H. Schwamm, R. G. Gonzalez, et al.
CT Angiography With Whole Brain Perfused Blood Volume Imaging: Added Clinical Value in the Assessment of Acute Stroke
Stroke,
April 1, 2002;
33(4):
959 - 966.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Briggs, R. A. Felberg, M. D. Malkoff, P. Bratina, and J. C. Grotta
Should Mild or Moderate Stroke Patients Be Admitted to an Intensive Care Unit?
Stroke,
April 1, 2001;
32(4):
871 - 876.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. C. Diener, E. B. Ringelstein, R. von Kummer, H. D. Langohr, H. Bewermeyer, H. Landgraf, M. Hennerici, D. Welzel, M. Grave, J. Brom, et al.
Treatment of Acute Ischemic Stroke With the Low-Molecular-Weight Heparin Certoparin : Results of the TOPAS Trial
Stroke,
January 1, 2001;
32(1):
22 - 29.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Brott and J. Bogousslavsky
Treatment of Acute Ischemic Stroke
N. Engl. J. Med.,
September 7, 2000;
343(10):
710 - 722.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Alexandrov, R. A. Felberg, A. M. Demchuk, I. Christou, W. S. Burgin, M. Malkoff, A. W. Wojner, and J. C. Grotta
Deterioration Following Spontaneous Improvement : Sonographic Findings in Patients With Acutely Resolving Symptoms of Cerebral Ischemia
Stroke,
April 1, 2000;
31(4):
915 - 919.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Alexandrov, A. M. Demchuk, R. A. Felberg, I. Christou, P. A. Barber, W. S. Burgin, M. Malkoff, A. W. Wojner, and J. C. Grotta
High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring
Stroke,
March 1, 2000;
31(3):
610 - 614.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Intravenous Danaparoid in Acute Stroke
Journal Watch (General),
August 17, 1999;
1999(817):
4 - 4.
[Full Text]
|
|
|
|
