Abstract TMP7: Acute Stroke Involving More Than 1/3 Mca Territory On Plain Ct Brain Is Not A Contraindication For Iv Thrombolysis.
Background and Purpose: Intravenously administered tissue plasminogen activator (IV- tPA) remains the only approved therapeutic agent to achieve arterial recanalization in acute ischemic stroke (AIS). Involvement of more than one-third of middle cerebral artery (MCA) territory on initial brain CT is a relative contraindication for IV-tPA and often associated with poor functional outcome at 3 months. We present the results of IV-thrombolysis among these patients at our tertiary center.
Methods: Data for consecutive stroke patients treated with IV-tPA within 4.5 hours of symptom onset were retrospectively analyzed. Data was collected for demographic characteristics, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores, and blood pressure levels before IV-tPA bolus. The presence of early stroke signs involving more than one-third of the MCA on the initial CT scan was measured by Alberta Stroke Program Early CT score (ASPECTS <8). Outcomes were assessed by modified Rankin Scale (mRS) score at 3 months.
Results: A total of 97 AIS patients with more than one-third MCA involvement received IV-tPA during the study period. Median age was 70 yrs (range 38-89), 54% male, median NIHSS score 20 points (range 3-30) and median onset-to-treatment time 152 minutes (range ). Forty-two (43.5%) patients achieved good functional outcomes at 3 months (mRS score 0-1). The factors associated with good outcome at 3 months on univariate analysis were younger age and lower NIHSS score at presentation. After multivariate analysis, lower NIHSS scores at presentation was noted as the only independent predictor of good outcome at 3 months (OR 0.918 95%CI 0.880 - 0.958 p=0.001. 1/3 MCA involvement on the initial CT scan (ASPECTS <8) was not significantly associated with a poorer functional outcome at 3 months (OR 1.495 95% CI 0.881-2.540; p=0.136).
Conclusions: Patients with acute stroke involving more than one-third of the MCA on initial brain CT scan, especially if associated with lower NIHSS score, should not be excluded from systemic thrombolysis.
- © 2012 by American Heart Association, Inc.