Early CT Changes Do Not Predict Parenchymal Haemorrhage Following Streptokinase Therapy In Acute Stroke.
Aims Recent thrombolytic trials in acute stroke, and acute treatment in the USA, exclude patients with early CT changes of infarction affecting greater than one third of the middle cerebral artery (MCA) territory because of a possible increased risk of parenchymal haemorrhage. We reviewed CT scans of patients recruited into the Australian Streptokinase Trial to determine whether such changes or other factors were predictive in this group of patients. Methodology Acute CT scans were classified by three neurology research fellows according to ECASS criteria in 264 patients. Where consensus was not reached, a panel of ECASS trained physicians reviewed the scans. Haemorrhage on second CT were classified into haemorrhagic infarction or parenchymal haemorrhage. Results CT s showed no acute changes in 36%, minor ischaemic changes (<1/3 MCA territory) in 29%, and major ischaemic changes (>1/3 MCA territory) in 35%. Major early ischaemic changes were predictive of haemorrhagic infarction (p=0.037) and stroke death (p= <0.001). Major changes were not predictive of parenchymal haemorrhage (O.R.=0.70 95% C.I.= 0.30 - 1.66). Parenchymal haemorrhage was not more likely with any early CT changes or delays in time to therapy but was predictive of death and severe disability. Systolic blood pressure prior to treatment was significantly higher in patient s with secondary parenchymal haemorrhage(p = 0.03). Discussion Early CT changes were predictive of poor outcome but not predictive of parenchymal haemorrhage. The risk of parenchymal haemorrage was increased with moderately increased systolic blood pressure. Excluding patients with high risk of parenchymal haemorrhage, may improve the safety and overall efficacy of thrombolytic therapy. The findings of this study do not support the exclusion of patients on CT criteria.