BACKGROUND: Standard selection criteria for thrombolysis typically exclude patients with acute ischemic stroke with unclear onset. Multimodal MRI screening may be able to identify those with a favorable benefit-risk ratio for thrombolysis. We aimed to evaluate the safety and efficacy of MRI-based thrombolysis in unclear-onset stroke (UnCLOS). METHODS: We reviewed the thrombolysis database registries from 3 medical centers in Korea. Subjects received thrombolysis with intravenous tissue plasminogen activator (tPA) or combined intravenous tPA and intra-arterial urokinase within 3 h, or intra-arterial urokinase within 6 h from symptom detection. For patients with UnCLOS, MRI-specific eligibility criteria (i.e. positive perfusion-diffusion mismatch and absence of well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions) were applied. Rates of immediate and 5-day recanalization, early neurological improvement and symptomatic intracranial hemorrhage (ICH) within 48 h after treatment and 3-month modified Rankin Scale (mRS) scores were compared between patients with UnCLOS and those with clear-onset stroke (CLOS). RESULTS: 32 patients with UnCLOS and 223 patients with CLOS were included. Baseline characteristics were comparable between the two groups, except that the proportion of MRI screening was higher, and detection-to-door time and door-to-needle time were longer in the UnCLOS group (p < 0.01). Rates of recanalization (immediate, 81.3 vs. 63.1%; delayed, 80.6 vs. 69.1%), early neurological improvement (on day 1, 46.9 vs. 35.9%; on day 7, 50.0 vs. 49.3%), symptomatic ICH (6.3 vs. 5.8%) and 3-month outcome (mRS 0-1, 37.5 vs. 35.0%; mRS 0-2, 50.0 vs. 49.3%) did not differ between the UnCLOS and CLOS groups. CONCLUSION: These preliminary results suggest that thrombolysis based on MRI criteria may safely be applied to acute stroke patients with unclear onset. 2008 S. Karger AG, Basel.
BACKGROUND: Standard selection criteria for thrombolysis typically exclude patients with acute ischemic stroke with unclear onset. Multimodal MRI screening may be able to identify those with a favorable benefit-risk ratio for thrombolysis. We aimed to evaluate the safety and efficacy of MRI-based thrombolysis in unclear-onset stroke (UnCLOS). METHODS: We reviewed the thrombolysis database registries from 3 medical centers in Korea. Subjects received thrombolysis with intravenous tissue plasminogen activator (tPA) or combined intravenous tPA and intra-arterial urokinase within 3 h, or intra-arterial urokinase within 6 h from symptom detection. For patients with UnCLOS, MRI-specific eligibility criteria (i.e. positive perfusion-diffusion mismatch and absence of well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions) were applied. Rates of immediate and 5-day recanalization, early neurological improvement and symptomatic intracranial hemorrhage (ICH) within 48 h after treatment and 3-month modified Rankin Scale (mRS) scores were compared between patients with UnCLOS and those with clear-onset stroke (CLOS). RESULTS: 32 patients with UnCLOS and 223 patients with CLOS were included. Baseline characteristics were comparable between the two groups, except that the proportion of MRI screening was higher, and detection-to-door time and door-to-needle time were longer in the UnCLOS group (p < 0.01). Rates of recanalization (immediate, 81.3 vs. 63.1%; delayed, 80.6 vs. 69.1%), early neurological improvement (on day 1, 46.9 vs. 35.9%; on day 7, 50.0 vs. 49.3%), symptomatic ICH (6.3 vs. 5.8%) and 3-month outcome (mRS 0-1, 37.5 vs. 35.0%; mRS 0-2, 50.0 vs. 49.3%) did not differ between the UnCLOS and CLOS groups. CONCLUSION: These preliminary results suggest that thrombolysis based on MRI criteria may safely be applied to acute strokepatients with unclear onset. 2008 S. Karger AG, Basel.
Authors: Bruce C V Campbell; Craig Costello; Søren Christensen; Martin Ebinger; Mark W Parsons; Patricia M Desmond; P Alan Barber; Kenneth S Butcher; Christopher R Levi; Deidre A De Silva; Maarten G Lansberg; Michael Mlynash; Jean-Marc Olivot; Matus Straka; Roland Bammer; Gregory W Albers; Geoffrey A Donnan; Stephen M Davis Journal: Cerebrovasc Dis Date: 2011-10-08 Impact factor: 2.762
Authors: Ruchira Jha; Thomas W K Battey; Ly Pham; Svetlana Lorenzano; Karen L Furie; Kevin N Sheth; W Taylor Kimberly Journal: Stroke Date: 2014-03-11 Impact factor: 7.914
Authors: Lee H Schwamm; Ona Wu; Shlee S Song; Lawrence L Latour; Andria L Ford; Amie W Hsia; Alona Muzikansky; Rebecca A Betensky; Albert J Yoo; Michael H Lev; Gregoire Boulouis; Arne Lauer; Pedro Cougo; William A Copen; Gordon J Harris; Steven Warach Journal: Ann Neurol Date: 2018-04-27 Impact factor: 10.422