Abstract TP34: Is there an Added Value for Vascular Imaging Prior to Administration of Intravenous tPA in Patients with Acute Middle Cerebral Artery Occlusion
Background and objectives: Advanced neurovascular imaging with CT or MR angiography (CTA/MRA) adds information regarding the vascular pathology and prognosis but may delay treatment with intravenous tissue plasminogen activator (tPA) in patients with proximal middle cerebral artery occlusions (pMCAO).
Methods: Patients with pMCAO included in our prospective stroke registry were identified. Stroke severity was measured with the National Institutes of Health Stroke Scale (NIHSS) and only patients presenting with NIHSS>10 were included. Patients underwent multi-parametric imaging studies whenever possible. Patients that underwent CTA/MRA were compared to those that only had a non-contrast CT prior to tPA. Disability was measured with the modified Ranking Scale (mRS) and shifts towards favorable outcomes (mRS≤2) were analyzed. Logistic regression was used to determine outcome modifiers.
Results: We included 73 patients (median age 73, 52% men) with moderate-severe stroke (median admission NIHSS 14). Forty four patients had a neurovascular imaging study and 29 did not have such a study. There were no differences between the groups in risk factor profile or baseline characteristics including stroke severity and door to needle, door to imaging or imaging to treatment times. At 90 days post stroke there were no statistically significant differences in mortality or favorable outcomes between the groups. On multivariate analysis performance of CTA/MRA had no impact on the chances of obtaining favorable outcome at day 90 after stroke.
Conclusions: Advanced neurovascular imaging studies do not delay treatment with tPA but do not impact the outcome of patients with pMCAO treated with tPA and may therefore be unnecessary in the acute stage prior to administration of tPA.
- © 2012 by American Heart Association, Inc.