Abstract
Purpose: Recent trials have demonstrated superior outcomes with combination IV-tPA and endovascular
therapy (EVT) within 6 hours of symptom onset in patients with proximal vessel occlusion
(ICA, M1, or proximal M1/M2) compared to IV-tPA alone. The current standard of diagnosis
for consideration of EVT is CT angiogram (CTA). Unfortunately, not all hospitals are
equipped with CTA, and the decision to transfer to tertiary centers is often based
on nonenhanced CT. Ipsilateral conjugate gaze deviation (CGD) is associated with worse
outcomes and larger infarcts in acute ischemic stroke. We predicted that the more
proximal the occlusion, the higher the degree of CGD. Materials and Methods: Over a period of 12 months, 182 consecutive patients with acute ischemic stroke
treated at our institution were prospectively analyzed. Stroke locations were categorized
based on CTA. Average degree of CGD was measured. Patient demographics, ASPECTS, collateral
score, National Institutes of Health Stroke Scale, modified Rankin Scale, TICI score,
length-of-stay, and mortality were collected. The median follow-up was 30 days. Results: Out of ninety one of 182 patients with (+) CGD, 82 (90%) patients had ICA or middle
cerebral artery (MCA) territory infarcts. The median was 25.0° in those with proximal
occlusion and 13.7° in those with distal MCA occlusion (P < .001). A higher degree of CGD is positively correlated with proximity of vessel
occlusion (correlation coefficient 0.2; P < .05). A cut-off greater than 20.25° (area under the curve = .76) showed a sensitivity
of 64.0% and specificity 84.2%. Conclusions: Measuring degree of CGD may help in early identification of proximal vessel occlusions
and expedite transfer for clot retrieval.
Key Words
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Article info
Publication history
Published online: January 14, 2019
Accepted:
December 26,
2018
Received in revised form:
December 22,
2018
Received:
October 24,
2018
Footnotes
Sources of funding: This work was supported by funding from Hamilton Health Sciences (grant number 2382) and McMaster University (grant number 2382).
Disclosures: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.12.037
Copyright
© 2019 Published by Elsevier Inc. on behalf of National Stroke Association.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Potential Clinical and Radiographic Horizontal Gaze Deviation an Early Sign of StrokeJournal of Stroke and Cerebrovascular DiseasesVol. 28Issue 12
- PreviewThe recent article from Jiang et al “Degree of Conjugate Gaze Deviation on CT Predicts Proximal Vessel Occlusion and May Expedite Endovascular Therapy,” Journal of Stroke and Cerebrovascular Disease 2019; 28:1093-10981 provides valuable information that may lead to early stroke intervention. They found that radiographic horizontal gaze deviation (h-CGD) detected by CTA is frequently associated with a proximal arterial occlusion (either ICA or proximal segments of the MCA); the h-CGD was always ipsilesional.
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