Abstract T P61: Patients With Acute Stroke Involving More Than One-Third Middle Cerebral Artery Territory Should Not be Excluded From Intravenous Thrombolysis
Background and aim: 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 increased bleeding risk. Involvement of more than 1/3 MCA territory on initial CT is associated with poor functional outcome at 3 months. We present the results of IV-thrombolysis among these patients at our tertiary care centre.
Methods: Data from consecutive acute ischemic stroke (AIS) patients treated with IV-tPA within 4.5 hours between January 2009 to August 2012 were included. The collected data included 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 1/3 of the MCA on the initial CT scan was measured by Alberta Stroke Program Early CT score (ASPECTS ≤7). 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), 55% male, median NIHSS score 20 points (range 3-33) and median onset-to-treatment time 152 minutes (range 55-274). Forty-two (44%) patients achieved good functional outcomes at 3 months (mRS score 0-1). Factors associated with good outcome at 3 months on univariate analysis were younger age, hypertension, non-cardioembolic etiology and lower NIHSS score at presentation. After multivariate analysis, lower age (OR 0.965; 95%CI 0.941-0.989, p=0.005) and lower NIHSS scores at presentation were noted as independent predictor of good outcome at 3 months (OR 0.990; 95%CI 0.869-0,950 p= <0.001 ). The presence of more than1/3 MCA involvement on the ore-thrombolysis CT scan (ASPECTS <8) was not associated with a poor 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.
Author Disclosures: L. yeo: None. P. Paliwal: None. B.P.L. Chan: None. H. Teoh: None. V.H.T. Ong: None. V. Sharma: None.
- © 2014 by American Heart Association, Inc.