Acute stroke: usefulness of early CT findings before thrombolytic therapy

Radiology. 1997 Nov;205(2):327-33. doi: 10.1148/radiology.205.2.9356611.


Purpose: To determine whether the extent of subtle parenchymal hypoattenuation detected on computed tomographic (CT) scans obtained within 6 hours of ischemic stroke is a factor in predicting patients' response to thrombolytic treatment.

Materials and methods: The baseline CT scans of 620 patients, who received either recombinant tissue plasminogen activator (rt-PA) or a placebo, in a double-blind, randomized multicenter trial were prospectively evaluated and assigned to one of three categories according to the extent of parenchymal hypoattenuation: none, 33% or less (small), or more than 33% (large) of the middle cerebral artery territory. The association between the extent of hypoattenuation on the baseline CT scans and the clinical outcome in the placebo-treated and the rt-PA-treated groups after 3 months was analyzed.

Results: In 215 patients with a small hypoattenuating area, treatment increased the chance of good outcome. In 336 patients with a normal CT scan and in 52 patients with a large hypoattenuating area, rt-PA had no beneficial effect but increased the risk for fatal brain hemorrhage.

Conclusion: The response to rt-PA in patients with ischemic stroke can be predicted on the basis of initial CT findings of the extent of parenchymal hypoattenuation in the territory of the middle cerebral artery.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Aged
  • Brain / diagnostic imaging
  • Brain Edema / diagnostic imaging
  • Brain Edema / etiology
  • Cerebral Angiography
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / drug therapy
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Recombinant Proteins / therapeutic use
  • Thrombolytic Therapy* / adverse effects
  • Time Factors
  • Tissue Plasminogen Activator / adverse effects
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, X-Ray Computed*
  • Treatment Outcome


  • Recombinant Proteins
  • Tissue Plasminogen Activator