ABSTRACT
PURPOSE: To prospectively evaluate the prognostic impact of multimodal computed tomography-based imaging in ischemic stroke patients potentially eligible for reperfusion therapy. METHODS: Anterior circulation stroke patients underwent non-contrast CT (NCCT), CT-angiography, and CT-perfusion within 12 h from symptom-onset. Patients could be treated with intravenous-tissue plasminogen activator (IV-tPA), endovascular or combined reperfusion therapies. Cerebral imaging profiles (IP) were NCCT-Alberta Stroke Program Early CT Score (ASPECTS) > 7 (IP1); NCCT-ASPECTS > 5 and proximal occlusion on CT-angiography (IP2); CT-perfusion mismatch between cerebral blood volume (CBV)-ASPECTS, and cerebral blood flow (CBF)-ASPECTS ≥ 2 (IP3). Favorable outcome was defined as modified Rankin Scale ≤ 2 at 3 months. RESULTS: Of 102 included patients, 62 (61%) received any reperfusion therapy. In IP2 and IP3, favorable outcome was more frequent in patients with reperfusion therapy than in those without; however, this did not reach statistical significance (IP2: 39% vs 15%, p = 0.26; IP3: 50% vs 17 %; p = 0.31). No difference was seen in IP1 (58% vs 58%, p = 1.0). In IP2, patients with IV-tPA alone achieved better functional outcome (50% vs 11%, p = 0.03) and lower mortality (0% vs 28%, p = 0.045) than those without. CONCLUSIONS: Our results suggest a benefit with imaging profile selection based upon the combination of a small-to-moderate-sized infarction and a visible intracranial occlusion in patients receiving IV-tPA. Reperfusion therapy may be futile in patients without proven vessel occlusion.
Subject(s)
Cerebral Angiography/methods , Multimodal Imaging/methods , Stroke/diagnostic imaging , Stroke/therapy , Tissue Plasminogen Activator/administration & dosage , Tomography, X-Ray Computed/methods , Aged , Female , Fibrinolytic Agents/administration & dosage , Humans , Injections, Intravenous , Male , Prognosis , Prospective Studies , Reperfusion/methods , Reproducibility of Results , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Within the last years psychosocial care in acute medicine has become more and more important. Therefore different conceptional structures are discussed to optimize the integration into primary care medicine, especious psychosomatic or psychosocial consultation and liaison services. Having resumed the concepts and practice of psychosocial care in oncology this paper describes a psychosocial liaison service accompanying a research project in psychooncology. The representation focuses the experience with psychosocial care of cancer patients over the last three years. Based on a systematic clinical documentation the activities are described with regard to psychosocial indication, patient assignment, patients needs during acute treatment and the different kinds of psychosocial interventions applied. The experiences are evaluated regarding the target groups (patients, relatives, medical staff) and associated problems of cooperation and organisation met with medical staff. Finally needs, possibilities and limits of psychosocial liaison services are discussed comparing the experiences with others reported in the literature.
