Utility of Computed Tomographic Perfusion in Thrombolysis for Minor Stroke

Stroke. 2016 Jul;47(7):1914-6. doi: 10.1161/STROKEAHA.116.013021. Epub 2016 May 19.

Abstract

Background and purpose: The use of thrombolysis in acute minor ischemic stroke (MIS) remains controversial. We sought to determine the safety and efficacy of intravenous tissue-type plasminogen activator (IV-tPA) in acute MIS patients with demonstrable penumbra on computed tomographic perfusion study.

Methods: Consecutive MIS patients with National Institutes of Health Stroke Scale ≤3 were identified from a prospective single tertiary-center database over a 4.5-year period (2011-2015). Cases with demonstrable penumbra were analyzed according to treatment received: IV-tPA versus standard stroke-unit care without thrombolysis.

Results: Seventy-three patients of 195 acute MIS admissions had a demonstrable penumbra (34 IV-tPA versus 39 standard stroke-unit care). Overall median National Institutes of Health Stroke Scale and premorbid modified Rankin Scale were 2 and 0, respectively. Median age was 73.2 (interquartile range, 67.3-82.8) years. There were no differences in baseline demographics, risk factors, stroke localization and cause, rates of vascular occlusion (38.2% versus 38.5%; P=1.000), or mean penumbral volume (41.3 versus 25.1 mL; P=0.150; IV-tPA versus standard stroke-unit care) between groups. There were no symptomatic intracerebral hemorrhages in either group. Patients treated with IV-tPA were more likely to have an excellent functional outcome at discharge (88.2% versus 53.9%; P=0.002) and 90 days (91.2% versus 71.8%; P=0.042). Ordinal analysis demonstrated a favorable shift in modified Rankin Scale with IV-tPA both at discharge (odds ratio, 5.23; 95% confidence interval, 1.83-12.20) and 90 days (odds ratio, 4.35; 95% confidence interval, 1.77-11.36).

Conclusions: In selected MIS patients with demonstrable penumbra on computed tomographic perfusion, IV-tPA is safe and associated with significant improvement in functional outcome at discharge and 90 days.

Keywords: cerebrovascular disorders; intracranial embolism; perfusion; stroke; thrombosis; tissue-type plasminogen activator.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / drug therapy*
  • Female
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Neuroimaging*
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / adverse effects
  • Recombinant Proteins / therapeutic use
  • Recovery of Function
  • Retrospective Studies
  • Severity of Illness Index
  • Single-Blind Method
  • Thrombolytic Therapy* / adverse effects
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / adverse effects
  • Tissue Plasminogen Activator / therapeutic use*
  • Tomography, X-Ray Computed*
  • Treatment Outcome

Substances

  • Recombinant Proteins
  • Tissue Plasminogen Activator