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(Stroke. 2003;34:345.)
© 2003 American Heart Association, Inc.

Advances in Stroke 2002

Stroke Neuroimaging

Steven Warach, MD, PhD

From the Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Md.

Correspondence to Steven Warach, MD, PhD, National Institute of Neurological Disorders and Stroke, Stroke Branch, 36 Convent Drive, MSC 4129, Room 4A03, Bethesda, MD 20892-4129. E-mail warachs@ninds.nih.gov

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The year in neuroimaging of stroke began with a lively response to a paper published at the end of 2001 by the NINDS rt-PA Stroke Study Group regarding the controversial topic of the clinical significance of early subtle CT signs of ischemia in response to tPA therapy.¹ That paper continued the series of post-hoc analyses coming from the NINDS rt-PA clinical trial data to support the position that all patients selected by the criteria used for enrollment in these trials may benefit from acute rtPA therapy, regardless of specific baseline features. This study by Patel et al¹ was featured at the 2002 International Stroke Conference and engendered a passionate discussion both at the conference and in the literature² on the use of early CT ischemia signs as potentially exclusionary criteria. The study reviewed CT films from the trial, generated from scanners of the early 1990s. After adjustment for group imbalances in several baseline clinical features, most notably clinical severity by NIH Stroke Scale, early ischemic changes were not predictive of symptomatic intracerebral hemorrhage, death at 90 days, or clinical deterioration at 24 hours. A marginal association was observed between overall 90-day outcome and early ischemic changes. When compared with the placebo patients without ischemic changes, only rtPA-treated patients without CT changes had favorable 90-day outcomes; however, within the subgroup of patients with most extensive CT changes, there did remain a treatment effect on the 90-day Rankin score. Modern scanners and analysis of the digital images are likely to be more . . . [Full Text of this Article]

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