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MRI-based intravenous thrombolysis in stroke patients with unknown time of symptom onset
Ist Teil von
European journal of neurology, 2012-02, Vol.19 (2), p.348-350
Ort / Verlag
Oxford, UK: Blackwell Publishing Ltd
Erscheinungsjahr
2012
Link zum Volltext
Quelle
Wiley Online Library Journals Frontfile Complete
Beschreibungen/Notizen
Background: Currently, stroke patients with unknown time of symptom onset (UTOS) are excluded from therapy with intravenous tissue Plasminogen Activator. We hypothesized that MRI‐based intravenous thrombolysis is safe in UTOS.
Methods: We analyzed radiological and clinical data as well as outcomes of stroke patients (including UTOS) who received intravenous thrombolytic therapy after MRI.
Results: Compared to patients with known time of symptom onset (n = 131), UTOS (n = 17) were older (81, 71–88 vs. 75 years, 66–82, P = 0.03), had a longer median time between last‐seen‐well and thrombolysis (12.3 h, IQR 11.5–15.2 h vs. 2.1 h, 1.8–2.8 h, P < 0.01), had a longer median door‐to‐needle time (86 min, 49–112 vs. 60 min, 49–76, P = 0.02), and a higher rate of arterial obstruction on MR‐angiography (82.4% vs. 56.5%, P = 0.04). No symptomatic intracerebral hemorrhage occurred in UTOS. After 3 months, there was no significant difference between groups concerning good functional outcome (modified Rankin Scale 0–2; 35.3% vs. 49.6%, P = 0.26) or mortality (0% vs. 15.3%, P = 0.08). In multivariate analyses including age, gender, baseline NIHSS, and atrial fibrillation UTOS did not have an independent effect on good functional outcome after 3 months (OR 1.16; 0.32–4.12, P = 0.81).
Conclusions: Thrombolysis after MRI seems safe and effective in UTOS. This observation may encourage those who plan prospective placebo‐controlled trials of thrombolytics in this subgroup of stroke patients.