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MRI‐based intravenous thrombolysis in stroke patients with unknown time of symptom onset
Author(s) -
Ebinger M.,
Scheitz J. F.,
Kufner A.,
Endres M.,
Fiebach J. B.,
Nolte C. H.
Publication year - 2012
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2011.03504.x
Subject(s) - medicine , thrombolysis , modified rankin scale , stroke (engine) , tissue plasminogen activator , intracerebral hemorrhage , placebo , atrial fibrillation , fibrinolytic agent , randomized controlled trial , cardiology , anesthesia , surgery , ischemic stroke , glasgow coma scale , ischemia , myocardial infarction , mechanical engineering , alternative medicine , pathology , engineering
Background: Currently, stroke patients with unknown time of symptom onset (UTOS) are excluded from therapy with intravenous tissue Plasminogen Activator. We hypothesized that MRI‐based intravenous thrombolysis is safe in UTOS. Methods: We analyzed radiological and clinical data as well as outcomes of stroke patients (including UTOS) who received intravenous thrombolytic therapy after MRI. Results: Compared to patients with known time of symptom onset ( n = 131), UTOS ( n = 17) were older (81, 71–88 vs. 75 years, 66–82, P = 0.03), had a longer median time between last‐seen‐well and thrombolysis (12.3 h, IQR 11.5–15.2 h vs. 2.1 h, 1.8–2.8 h, P < 0.01), had a longer median door‐to‐needle time (86 min, 49–112 vs. 60 min, 49–76, P = 0.02), and a higher rate of arterial obstruction on MR‐angiography (82.4% vs. 56.5%, P = 0.04). No symptomatic intracerebral hemorrhage occurred in UTOS. After 3 months, there was no significant difference between groups concerning good functional outcome (modified Rankin Scale 0–2; 35.3% vs. 49.6%, P = 0.26) or mortality (0% vs. 15.3%, P = 0.08). In multivariate analyses including age, gender, baseline NIHSS, and atrial fibrillation UTOS did not have an independent effect on good functional outcome after 3 months (OR 1.16; 0.32–4.12, P = 0.81). Conclusions: Thrombolysis after MRI seems safe and effective in UTOS. This observation may encourage those who plan prospective placebo‐controlled trials of thrombolytics in this subgroup of stroke patients.