Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke
- 1 April 2011
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 42 (4), 1129-1131
- https://doi.org/10.1161/strokeaha.110.605766
Abstract
The value of multimodal CT to assist thrombolysis has received little attention in stroke. We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005–2009). Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50–5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68–11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80–2.16; interaction test P =0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups. Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings.This publication has 6 references indexed in Scilit:
- Recommendations for Imaging of Acute Ischemic StrokeStroke, 2009
- Quantitative Assessment of Core/Penumbra Mismatch in Acute StrokeStroke, 2008
- Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trialThe Lancet Neurology, 2008
- Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatmentNeurology, 2007
- Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) studyAnnals of Neurology, 2006
- MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort studyThe Lancet Neurology, 2006