Multimodal CT-assisted thrombolysis in patients with acute stroke: a cohort study

Stroke. 2011 Apr;42(4):1129-31. doi: 10.1161/STROKEAHA.110.605766. Epub 2011 Feb 17.


Background and purpose: The value of multimodal CT to assist thrombolysis has received little attention in stroke.

Methods: 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).

Results: 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.

Conclusions: 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.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Fibrinolysis / drug effects
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Stroke / diagnostic imaging*
  • Stroke / drug therapy*
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / adverse effects
  • Tomography, X-Ray Computed / adverse effects
  • Tomography, X-Ray Computed / methods*


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator