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Early magnetic resonance imaging findings in patients receiving tissue plasminogen activator predict outcome: Insights into the pathophysiology of acute stroke in the thrombolysis era
Author(s) -
Chalela Julio A.,
Kang DongWha,
Luby Marie,
Ezzeddine Mustapha,
Latour Lawrence L.,
Todd Jason W.,
Dunn Billy,
Warach Steven
Publication year - 2004
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.10781
Subject(s) - medicine , thrombolysis , tissue plasminogen activator , magnetic resonance imaging , modified rankin scale , confidence interval , stroke (engine) , odds ratio , t plasminogen activator , perfusion scanning , perfusion , cardiology , effective diffusion coefficient , penumbra , fibrinolytic agent , nuclear medicine , radiology , ischemia , ischemic stroke , mechanical engineering , myocardial infarction , engineering
We measured ischemic brain changes with diffusion and perfusion MRI in 42 ischemic stroke patients before and 2 hours (range approximately 1.5 to 4.5 hours) after standard intravenous tissue plasminogen activator (tPA) therapy. The median time from stroke onset to tPA was 131 minutes. Clinical and MRI variables (change in perfusion and/or diffusion weighted lesion volume) were compared between those with excellent outcome defined as 3‐month modified Rankin score (mRS) of 0 to 1 and those with incomplete recovery (mRS >1). In multivariate logististic regression analysis, the most powerful independent predictor for excellent outcome was improved brain perfusion: hypoperfusion volume on mean transit time (MTT) map decrease >30% from baseline to 2‐hour post tPA scan (p=0.009; odds ratio [95% confidence interval], 20.7 [2.1‐203.9]). Except for age < 70 years, no other baseline clinical or imaging variable was an independent predictor of outcome. We propose MTT lesion volume decrease more than 30% 2 hours after tPA as an early marker of long‐term clinical benefit of thrombolytic therapy.