Abstract W MP35: The Re-examining Acute Eligibility for Thrombolysis Task Force Criteria for Defining Rapidly Improving Stroke Symptoms: A Pilot Prospective Study of tPA Treatment Decisions
Background: Rapidly Improving Stroke Symptoms (RISS) is a controversial exclusion criterion for tPA for acute ischemic stroke (AIS). Prior studies suggest 4-44% of AIS patients eligible are not given tPA solely because of RISS and their outcome is not invariably benign. In 2013 The Re-examining Acute Eligibility for Thrombolysis (TREAT) Task Force published new criteria for defining RISS.
Objectives: To estimate frequency and outcome of RISS based on TREAT criteria in a prospective cohort of consecutive AIS patients.
Methods: Serial NIH Stroke Scales (NIHSS) for AIS patients admitted within 4.5 hrs of symptom onset were performed every 20 (±5) minutes until a treatment decision (tPA vs no tPA) was made, independent of the study. Improvement was calculated as the difference between baseline NIHSS (bNIHSS) and treatment decision NIHSS (tdNIHSS). Per TREAT criteria, RISS was defined as improvement to a non-disabling mild stroke and none of the following deficits present: complete hemianopsia; severe aphasia; visual or sensory extinction; any weakness limiting sustained effort against gravity; any total NIHSS >5; any remaining deficit considered potentially disabling by the patient and the treater. We compared frequency and outcomes of TREAT-based RISS with the most commonly used RISS definition [≥4 point improvement (4PI) on NIHSS]. Good outcome was defined as modified Rankin Scale of 0-1 at 3 months.
Results: Fifty AIS were enrolled: mean age 65 yrs; median bNIHSS=5 (IQR 2,11); median tdNIHSS=5 (IQR 2,9); tPA was given in 23 (46%). Five/50 (10%) were RISS according to TREAT criteria, all 5 had good outcome at 90 days without tPA. Five/50 (10%) were RISS according to 4PI, and only 2/5 (40%) had good outcome while 1/5 (20%) died.
Conclusions: This is the first preliminary, prospective estimate of RISS frequency and outcome according to TREAT criteria vs. a commonly used RISS definition. Our pilot data suggest the TREAT RISS frequency is in the lower end of prior retrospective estimates and, as a more restrictive definition, may better predict good outcome of RISS in future, larger studies.
Author Disclosures: C. Balucani: Research Grant; Significant; AHA/ASA/ABF Lawrence Brass, Post-Doctoral Fellowship13POST1477005. R. Bianchi: None. J. Weedon: None. S. Levine: Research Grant; Modest; Investigator initiated grant (IST ML28239) from Genentech, Inc..
This research has received full or partial funding support from the American Heart Association, Founders - Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont.
- © 2015 by American Heart Association, Inc.