Stroke. 2002;33:2438-2445
doi: 10.1161/01.STR.0000030109.12281.23
doi: 10.1161/01.STR.0000030109.12281.23
(Stroke. 2002;33:2438.)
© 2002 American Heart Association, Inc.
Original Contributions |
Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke <6 Hours
From the Department of Neurology, University Hospital, Hamburg Eppendorf (J.R., C.W.), Heidelberg (P.D.S., W.H.), Mannheim (A.G., K. Szabo, M.H.), Düsseldorf (M.S.), and Berlin Charite (A.V., G.J.J-H.); Department of Neuroradiology, University Hospital, Hamburg Eppendorf (J.F., T.K., H.Z.), Heidelberg (J.B.F., K. Sartor), and Kiel (O.J.); and Institute for Mathematics and Data Science in Medicine (V.S.), University Hospital, Hamburg Eppendorf, Germany.
Correspondence to Joachim Röther, Department of Neurology, University Hospital Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany. E-mail roether{at}uke.uni-hamburg.de
Background and Purpose— The goals of this study were to examine MRI baseline characteristics of patients with acute ischemic stroke (AIS) and to study the influence of intravenous tissue plasminogen activator (tPA) on MR parameters and functional outcome using a multicenter approach.
Methods— In this open-label, nonrandomized study of AIS patients with suspected anterior circulation stroke, subjects received a multiparametric stroke MRI protocol (diffusion- and perfusion-weighted imaging and MR angiography) within 6 hours after symptom onset and on follow-up. Patients were treated either with tPA (thrombolysis group) or conservatively (no thrombolysis group). Functional outcome was assessed on day 90 (modified Rankin Score; mRS).
Results— We enrolled 139 AIS patients (no thrombolysis group, n=63; thrombolysis group, n=76). Patients treated with tPA were more severely affected (National Institutes of Health Stroke Scale score, 10 versus 13; P=0.002). Recanalization rates were higher in the thrombolysis group (Thrombolysis in Myocardial Infarction criteria 1 through 3 on day 1; 66.2% versus 32.7%; P<0.001). Proximal vessel occlusions resulted in larger infarct volumes and worse outcome (P=0.02). Thrombolysis was associated with a better outcome regardless of the time point of tPA treatment (
3 hours or 3 to 6 hours) (univariate analysis: mRS 2, P=0.017; mRS 1, P=0.023). Age (P=0.003), thrombolytic therapy at 0 to 6 hours (P=0.01), recanalization (P=0.016), lesion volume on day 7 (P=0.001), and initial National Institutes of Health Stroke Scale score (P=0.001) affected functional outcome (mRS on day 90) positively (multivariate analysis). The time point of tPA therapy affected the recanalization rate (P=0.024) but not final infarct volume.
Conclusions— In this pilot study, tPA therapy had a beneficial effect on vessel recanalization and functional outcome. Multiparametric MRI delineates tissue at risk of infarction in AIS patients, which may be helpful for the selection of patients for tPA therapy. tPA therapy appeared safe and effective beyond a 3-hour time window. This study delivers the rationale for a randomized, MR-based tPA trial.
Key Words: diffusion • magnetic resonance imaging • perfusion • stroke • thrombolytic therapy
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M. D. Hill, S. B. Coutts, J.H. W. Pexman, A. M. Demchuk, P. Schramm, P. D. Schellinger, J. B. Fiebach, W. Hacke, and K. Sartor CTA Source Images in Acute Stroke Stroke, April 1, 2003; 34(4): 835 - 837. [Full Text] [PDF]
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E. Grips, M. Daffertshofer, M. Hennerici, and H. P. Adams Jr Banning Anticoagulation in Stroke or Consequence of Poor Study Design Stroke, April 1, 2003; 34 (4): 837 - 839. [Full Text] [PDF]
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S. Warach Stroke Neuroimaging Stroke, February 1, 2003; 34(2): 345 - 347. [Full Text] [PDF]
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P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]
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