Abstract W P56: Negative FLAIR-based Intravenous Thrombolysis in Acute Stroke Patients With Unknown Onset Time
BACKGROUND AND PURPOSE: Approximately 25% of acute stroke patients were excluded from intravenous thrombolysis using tPA because of the unknown onset time. We previously reported that patients with unknown onset time would be able to receive tPA when showing no ischemia on the FLAIR (negative FLAIR). We assessed the safety and efficacy of tPA for those patients with ICAO and MCAO. METHODS:From June 2009 to June 2013, we prospectively treated stroke patients with unknown onset time using tPA who satisfied following criteria: negative FLAIR, anterior-circulation stroke, presence of major arterial occlusion, and the DWI-ASPECTS ≥5. tPA therapy was performed within 3 h from the first found abnormal time. Early recanalization was defined as new appearance of at least one of the distal branches within 1 h after tPA therapy on MRA. Dramatic recovery at day 7 was defined as ≥ 10-point reduction in the total NIHSS score or score of 0 or 1. A favorable outcome at 3 months was defined as a mRS score of 0-2. RESULTS:Subject comprised 24 patients (median age, 83 [68-90] years; 8 [33%] males). Eight (33%) patients had the ICAO (ICAO group), and 16 (67%) had the MCAO (MCAO group). NIHSS score was slightly higher in the ICAO group than the MCAO group (18 [17-20] vs. 16 [10-20], p=0.085). Median interval between the last seen normal time and admission was similar between patients in the ICAO group and the MCAO group (5.9 h [5.0-12.4] vs. 5.6 h [4.2-12.9], p=0.602). DWI-ASPECTS on admission tended to be higher in the ICAO and the MCAO groups (9 [8-10] vs. 8 [6-9], p=0.086). During the 7 days after stroke, none of the patients with ICAO and the MCAO groups experienced symptomatic cerebral hemorrhage (p=1.000). Regarding efficacy outcome, only 1 (13%) of the 8 patients in the ICAO group and 7 (44%) of the 16 patients in the MCAO group had early recanalization. Thus, the rate of dramatic recovery at day 7 was lower in the ICAO group than the MCAO group (13% vs. 63%, p=0.033). Among 17 patients with pre-morbid mRS 0-2, none (0%) of the 4 patients with ICAO group and 8 (62%) of the 13 patients achieved favorable outcome (p=0.082).
Conclusions: Acute MCAO patients with unknown onset time may benefit from tPA therapy when showing no ischemia on FLAIR. Yet, tPA therapy for patients with the ICAO should be ineffective.
Author Disclosures: J. Aoki: None. K. Kimura: None. K. Shibazaki: None. K. Nagai: None. N. Saji: None. J. Uemura: None. T. Sato: None. T. Ebata: None.
- © 2014 by American Heart Association, Inc.