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Intravenous Thrombolysis Increases the Rate of Dramatic Recovery in Patients with Acute Stroke with an Unknown Onset Time and Negative FLAIR MRI
Author(s) -
Aoki Junya,
Sakamoto Yuki,
Kimura Kazumi
Publication year - 2015
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12323
Subject(s) - medicine , fluid attenuated inversion recovery , thrombolysis , stroke (engine) , odds ratio , confidence interval , intracerebral hemorrhage , modified rankin scale , middle cerebral artery , tissue plasminogen activator , fibrinolytic agent , magnetic resonance imaging , cardiology , anesthesia , radiology , ischemia , ischemic stroke , subarachnoid hemorrhage , mechanical engineering , myocardial infarction , engineering
BACKGROUND AND PURPOSE The safety and feasibility of intravenous thrombolysis using recombinant tissue plasminogen activator (IV‐tPA) were retrospectively compared between patients with unknown onset time and no ischemia on fluid‐attenuated inversion recovery (negative FLAIR) and patients receiving standard therapy. METHODS Acute stroke patients with unknown onset times were treated using IV‐tPA if they had: negative FLAIR; internal carotid artery and/or middle cerebral artery occlusion; and a diffusion‐weighted imaging (DWI)‐Alberta Stroke Programme Early CT Score ≥5. All patients had abnormal DWI scans indicating an acute stroke. IV‐tPA therapy was performed within 3‐4.5 h of first found abnormal time (FAT). Patients who were admitted within 3‐4.5 h of FAT and did not receive IV‐tPA therapy despite the same imaging findings were extracted from our registry as controls. RESULTS There were 24 patients in the IV‐tPA group and 28 in the control group. None of the IV‐tPA group and 1 (4%) of the control group patients experienced symptomatic intracerebral hemorrhage ( P = 1.000). The rate of dramatic recovery at day 7 (≥10‐point reduction in the total National Institutes of Health Stroke Scale [NIHSS] score or NIHSS score of 0‐1) was 46% in the IV‐tPA group and 18% in the control group ( P = .038). Multivariate regression analysis revealed that IV‐tPA was an independent predictor of dramatic recovery at day 7 (odds ratio 13.74; 95% confidence interval, 1.95‐96.92; P = .009). CONCLUSIONS IV‐tPA may safely increase the rate of dramatic recovery in acute stroke patients with unknown onset times and negative FLAIR.