Published Online
on August 4, 2005

A more recent version of this article appeared on September 1, 2005

This Article Full Text (PDF) All Versions of this Article: 36/9/1939    most recent 01.STR.0000177539.72071.f0v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kang, D.-W. Search for Related Content PubMed PubMed Citation Articles by Kang, D.-W. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information MRI Scans Stroke Related Collections Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging Thrombolysis

Submitted on March 31, 2005
Revised on June 20, 2005
Accepted on June 27, 2005

MRI Screening Before Standard Tissue Plasminogen Activator Therapy Is Feasible and Safe

Dong-Wha Kang MD, PhD; Julio A. Chalela MD; William Dunn MD; Steven Warach MD, PhD^*; NIH-Suburban Stroke Center Investigators

From the Stroke Branch (D.-W.K., J.A.C., W.D., S.W.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; and Department of Neurology (D.-W.K.), Asan Medical Center, University of Ulsan, Seoul, South Korea.

^* To whom correspondence should be addressed. E-mail: WarachS{at}ninds.nih.gov.

Background and Purpose--MRI screening for thrombolytic therapy may improve patient selection. Alternatively, it may excessively delay treatment and thereby lead to worse outcomes. We hypothesized that times to treatment and outcomes in a stroke center with immediate MRI access and interpretation would not differ from those of the typical clinical practice.

Methods--We compared the results of 120 consecutive patients treated with intravenous tissue plasminogen activator (tPA) within 3 hours of onset at our center with those of the 2 largest multicenter registries of tPA use.^5,6 In addition to standard criteria, MRI specific eligibility criteria were applied in 97 patients. MRI was not performed in 23 patients because of contraindications to MRI or late patient arrival (>2.5 hours). Outcomes were the modified Rankin Scale (mRS) obtained at 3 months.

Results--Times to treatment (median door-to-needle time 81.5 minutes; median onset-to-needle time 135 minutes) and outcomes (mRS 0 to 1, 40.8%; mRS 0 to 2, 47.5%) were not inferior to those of the typical clinical practice. Door-to-needle time was shorter in computed tomography (CT) screening (67.5±22.5 minutes; n=23) than in MRI screening (86.8±21.5 minutes; n=97; P<0.001). However, outcomes were not different between MRI screening (mRS 0 to 1, 42.3%; mRS 0 to 2, 49.5%) and CT screening (mRS 0 to 1, 34.8%; mRS 0 to 2, 39.1%). Neither times to treatment nor MRI screening was predictive of outcomes.

Conclusion--These data demonstrate that MRI screening before tPA therapy is feasible and not associated with unacceptable times to treatment or outcomes.

Key words: stroke, acute • magnetic resonance imaging • thrombolysis

This article has been cited by other articles:

				A-H. Cho, J. S. Kim, S.-J. Kim, S.-C. Yun, C.-G. Choi, H.-R. Kim, S. U. Kwon, D.-H. Lee, E.-K. Kim, D.-C. Suh, et al. Focal Fluid-Attenuated Inversion Recovery Hyperintensity Within Acute Diffusion-Weighted Imaging Lesions Is Associated With Symptomatic Intracerebral Hemorrhage After Thrombolysis Stroke, December 1, 2008; 39(12): 3424 - 3426. [Abstract] [Full Text] [PDF]

				S. Siemonsen, T. Fitting, G. Thomalla, P. Horn, J. Finsterbusch, P. Summers, C. Saager, T. Kucinski, and J. Fiehler T2' Imaging Predicts Infarct Growth beyond the Acute Diffusion-weighted Imaging Lesion in Acute Stroke Radiology, September 1, 2008; 248(3): 979 - 986. [Abstract] [Full Text] [PDF]

				J. G. Merino, L. L. Latour, J. W. Todd, M. Luby, P. D. Schellinger, D.-W. Kang, and S. Warach Lesion Volume Change After Treatment With Tissue Plasminogen Activator Can Discriminate Clinical Responders From Nonresponders Stroke, November 1, 2007; 38(11): 2919 - 2923. [Abstract] [Full Text] [PDF]

				P. D. Schellinger, G. Thomalla, J. Fiehler, M. Kohrmann, C. A. Molina, T. Neumann-Haefelin, M. Ribo, O. C. Singer, O. Zaro-Weber, and J. Sobesky MRI-Based and CT-Based Thrombolytic Therapy in Acute Stroke Within and Beyond Established Time Windows: An Analysis of 1210 Patients Stroke, October 1, 2007; 38(10): 2640 - 2645. [Abstract] [Full Text] [PDF]

				J. Fiehler, G. W. Albers, J.-M. Boulanger, L. Derex, A. Gass, N. Hjort, J. S. Kim, D. S. Liebeskind, T. Neumann-Haefelin, S. Pedraza, et al. Bleeding Risk Analysis in Stroke Imaging Before ThromboLysis (BRASIL): Pooled Analysis of T2*-Weighted Magnetic Resonance Imaging Data From 570 Patients Stroke, October 1, 2007; 38(10): 2738 - 2744. [Abstract] [Full Text] [PDF]

				S. J. Phillips, D. Dai, A. Mitnitski, G. J. Gubitz, K. C. Johnston, W. J. Koroshetz, K. L. Furie, S. Black, D. E. Heiselman, and on behalf of the GAIN Americas Investigators Clinical Diagnosis of Lacunar Stroke in the First 6 Hours After Symptom Onset: Analysis of Data From the Glycine Antagonist In Neuroprotection (GAIN) Americas Trial Stroke, October 1, 2007; 38(10): 2706 - 2711. [Abstract] [Full Text] [PDF]

				C. Cordonnier, R. Al-Shahi Salman, and J. Wardlaw Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting Brain, August 1, 2007; 130(8): 1988 - 2003. [Abstract] [Full Text] [PDF]

				K. Danielyan, B.-S. Ding, C. Gottstein, D. B. Cines, and V. R. Muzykantov Delivery of Anti-Platelet-Endothelial Cell Adhesion Molecule Single-Chain Variable Fragment-Urokinase Fusion Protein to the Cerebral Vasculature Lyses Arterial Clots and Attenuates Postischemic Brain Edema J. Pharmacol. Exp. Ther., June 1, 2007; 321(3): 947 - 952. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]