In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 10 ( 2007-10), p. 2640-2645
Abstract:
Background and Purpose— The use of intravenous thrombolysis is restricted to a minority of patients by the rigid 3-hour time window. This window may be extended by using modern imaging-based selection algorithms. We assessed safety and efficacy of MRI-based thrombolysis within and beyond 3 hours compared with standard CT-based thrombolysis. Methods— Five European stroke centers pooled the core data of their CT- and MRI-based prospective thrombolysis databases. Safety outcomes were predefined as symptomatic intracranial hemorrhage and mortality. Primary efficacy outcome was a favorable outcome (modified Rankin Scale 0 to 1). We performed univariate and multivariate analyses for all end points, including age, National Institutes of Health Stroke Scale, treatment group (CT 〈 3 hours, MRI 〈 3 hours and 〉 3 hours), and onset to treatment time as variables. Results— A total of 1210 patients were included (CT 〈 3 hours: N=714; MRI 〈 3 hours: N=316; MRI 〉 3 hours: N=180). Median age, National Institutes of Health Stroke Scale, and onset to treatment time were 69, 67, and 68.5 years ( P =0.66); 12, 13, and 14 points ( P =0.019); and 130, 135, and 240 minutes ( P 〈 0.001). Symptomatic intracranial hemorrhage rates were 5.3%, 2.8%, and 4.4% ( P =0.213); mortality was 13.7%, 11.7%, and 13.3% ( P =0.68). Favorable outcome occurred in 35.4%, 37.0%, and 40% ( P =0.51). Age and National Institutes of Health Stroke Scale were independent predictors for all safety and efficacy outcomes. The overall use of MRI significantly reduced symptomatic intracranial hemorrhage (OR: 0.520, 95% CI: 0.270 to 0.999, P =0.05). Beyond 3 hours, the use of MRI significantly predicted a favorable outcome (OR: 1.467; 95% CI: 1.017 to 2.117, P =0.040). Within 3 hours and for all secondary end points, there was a trend in favor of MRI-based selection over standard 〈 3-hour CT-based treatment. Conclusion— Despite significantly longer time windows and significantly higher baseline National Institutes of Health Stroke Scale scores, MRI-based thrombolysis is safer and potentially more efficacious than standard CT-based thrombolysis.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/STROKEAHA.107.483255
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2007
detail.hit.zdb_id:
1467823-8
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