A I Qureshi1, M A Ezzeddine, A Nasar, M F K Suri, J F Kirmani, N Janjua, A A Divani. 1. Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA. aiqureshi@hotmail.com
Abstract
OBJECTIVE: To evaluate the effect of IV recombinant tissue plasminogen activator (rt-PA) in patients with hyperdense artery sign (HAS) on initial CT scan. METHODS: The authors determined the differential effect of IV rt-PA (0.9 mg/kg) in patients with HAS by testing the interaction of rt-PA and HAS in a logistic regression model after adjusting for age, sex, initial NIH Stroke Scale score (NIHSSS), time to randomization, systolic blood pressure, serum glucose, body temperature, and rt-PA in 616 patients treated within 3 hours of symptom onset. Outcomes evaluated included intracranial hemorrhage, modified Rankin scale (mRS) 0-1, Barthel Index (BI) of > or = 95, Glasgow Outcome Scale (GOS) of 0-1, NIHSSS 0-1, and death at 90 days. RESULTS: HAS was detected on the initial CT scan in 91 (15%) of the 616 patients by an independent neuroradiologist. Significantly lower rates of mRS 0-1, BI > or = 95, GOS of 0-1, or NIHSSS 0-1 at 90 days were observed among patients with HAS. IV rt-PA significantly increased the rates of mRS 0-1, BI > or = 95, GOS of 0-1, or NIHSSS 0-1 at 90 days after adjusting for potential confounders without any significant modifying effect (interaction) of HAS. Among the 91 patients with HAS, rt-PA use demonstrated a trend or significance for increased adjusted rates of favorable outcomes by mRS (p = 0.04), BI (p = 0.1), GOS (p = 0.03), and NIHSSS (p = 0.01). CONCLUSION: Although hyperdense artery sign is associated with poor outcome, IV recombinant tissue plasminogen activator may be beneficial in this subgroup of patients with ischemic stroke.
RCT Entities:
OBJECTIVE: To evaluate the effect of IV recombinant tissue plasminogen activator (rt-PA) in patients with hyperdense artery sign (HAS) on initial CT scan. METHODS: The authors determined the differential effect of IV rt-PA (0.9 mg/kg) in patients with HAS by testing the interaction of rt-PA and HAS in a logistic regression model after adjusting for age, sex, initial NIH Stroke Scale score (NIHSSS), time to randomization, systolic blood pressure, serum glucose, body temperature, and rt-PA in 616 patients treated within 3 hours of symptom onset. Outcomes evaluated included intracranial hemorrhage, modified Rankin scale (mRS) 0-1, Barthel Index (BI) of > or = 95, Glasgow Outcome Scale (GOS) of 0-1, NIHSSS 0-1, and death at 90 days. RESULTS: HAS was detected on the initial CT scan in 91 (15%) of the 616 patients by an independent neuroradiologist. Significantly lower rates of mRS 0-1, BI > or = 95, GOS of 0-1, or NIHSSS 0-1 at 90 days were observed among patients with HAS. IV rt-PA significantly increased the rates of mRS 0-1, BI > or = 95, GOS of 0-1, or NIHSSS 0-1 at 90 days after adjusting for potential confounders without any significant modifying effect (interaction) of HAS. Among the 91 patients with HAS, rt-PA use demonstrated a trend or significance for increased adjusted rates of favorable outcomes by mRS (p = 0.04), BI (p = 0.1), GOS (p = 0.03), and NIHSSS (p = 0.01). CONCLUSION: Although hyperdense artery sign is associated with poor outcome, IV recombinant tissue plasminogen activator may be beneficial in this subgroup of patients with ischemic stroke.
Authors: Adnan I Qureshi; Mushtaq H Qureshi; Iryna Lobanova; Asif Bashir; Asif A Khan; Stephen M Bologna; Michelle Peterson; M Fareed K Suri Journal: J Vasc Interv Neurol Date: 2016-01
Authors: J Puig; S Pedraza; A Demchuk; J Daunis-I-Estadella; H Termes; G Blasco; G Soria; I Boada; S Remollo; J Baños; J Serena; M Castellanos Journal: AJNR Am J Neuroradiol Date: 2011-12-08 Impact factor: 3.825
Authors: David S Liebeskind; Nerses Sanossian; William H Yong; Sidney Starkman; Michael P Tsang; Antonio L Moya; David D Zheng; Anna M Abolian; Doojin Kim; Latisha K Ali; Samir H Shah; Amytis Towfighi; Bruce Ovbiagele; Chelsea S Kidwell; Satoshi Tateshima; Reza Jahan; Gary R Duckwiler; Fernando Viñuela; Noriko Salamon; J Pablo Villablanca; Harry V Vinters; Victor J Marder; Jeffrey L Saver Journal: Stroke Date: 2011-03-10 Impact factor: 7.914