Kosmas Macha1, Philip Hoelter1, Gabriela Siedler1, Michael Knott1, Stefan Schwab1, Arnd Doerfler1, Bernd Kallmünzer2, Tobias Engelhorn1. 1. From the Departments of Neurology (K.M., G.S., S.S., B.K.) and Neuroradiology (P.H., M.K., A.D., T.E.), University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany. 2. From the Departments of Neurology (K.M., G.S., S.S., B.K.) and Neuroradiology (P.H., M.K., A.D., T.E.), University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany. bernd.kallmuenzer@uk-erlangen.de.
Abstract
OBJECTIVE: To investigate differences in procedure times, safety, and efficacy outcomes comparing 2 different protocols to enable thrombolysis in the extended or unknown time window after stroke onset with either multimodal CT or MRI. METHODS: Patients with ischemic stroke in the extended or unknown time window who received IV thrombolysis between January 2011 and May 2019 were identified from an institutional registry. Imaging-based selection was done by multimodal CT or MRI according to institutional treatment algorithms. RESULTS: IV thrombolysis was performed in 100 patients (54.3%) based on multimodal CT imaging and in 84 patients (45.7%) based on MRI. Baseline clinical data, including stroke severity and time from last seen normal to hospital admission, were similar in patients with CT and MRI. Door-to-needle times were shorter in patients with CT-based selection (median [interquartile range] 45 [37-62] minutes vs 75 [59-90] minutes; mean difference [95% confidence interval (CI)] -28 minutes [-35 to -21]). No differences were detected regarding the incidence of symptomatic intracranial hemorrhage (2 [2.0%] vs 4 [4.8%]; adjusted odds ratio [aOR] [95% CI] 0.47 [0.08-2.83]) and favorable outcome at day 90 (25 [33.8%] vs 33 [42.9%]; aOR 0.95 [0.45-2.02]). CONCLUSION: IV thrombolysis in ischemic stroke in the unknown or extended time window appeared safe in CT- and MRI-selected patients, while the use of CT imaging led to faster door-to-needle times. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with ischemic stroke in the extended or unknown time window, imaging-based selection for IV thrombolysis by multimodal CT compared to MRI led to shorter door-to-needle times.
OBJECTIVE: To investigate differences in procedure times, safety, and efficacy outcomes comparing 2 different protocols to enable thrombolysis in the extended or unknown time window after stroke onset with either multimodal CT or MRI. METHODS:Patients with ischemic stroke in the extended or unknown time window who received IV thrombolysis between January 2011 and May 2019 were identified from an institutional registry. Imaging-based selection was done by multimodal CT or MRI according to institutional treatment algorithms. RESULTS:IV thrombolysis was performed in 100 patients (54.3%) based on multimodal CT imaging and in 84 patients (45.7%) based on MRI. Baseline clinical data, including stroke severity and time from last seen normal to hospital admission, were similar in patients with CT and MRI. Door-to-needle times were shorter in patients with CT-based selection (median [interquartile range] 45 [37-62] minutes vs 75 [59-90] minutes; mean difference [95% confidence interval (CI)] -28 minutes [-35 to -21]). No differences were detected regarding the incidence of symptomatic intracranial hemorrhage (2 [2.0%] vs 4 [4.8%]; adjusted odds ratio [aOR] [95% CI] 0.47 [0.08-2.83]) and favorable outcome at day 90 (25 [33.8%] vs 33 [42.9%]; aOR 0.95 [0.45-2.02]). CONCLUSION:IV thrombolysis in ischemic stroke in the unknown or extended time window appeared safe in CT- and MRI-selected patients, while the use of CT imaging led to faster door-to-needle times. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with ischemic stroke in the extended or unknown time window, imaging-based selection for IV thrombolysis by multimodal CT compared to MRI led to shorter door-to-needle times.
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Authors: Urs Fischer; Mattia Branca; Leo H Bonati; Emmanuel Carrera; Maria I Vargas; Alexandra Platon; Zsolt Kulcsar; Susanne Wegener; Andreas Luft; David J Seiffge; Marcel Arnold; Patrik Michel; Davide Strambo; Vincent Dunet; Gian Marco De Marchis; Ludwig Schelosky; Gustav Andreisek; Filip Barinka; Nils Peters; Loraine Fisch; Krassen Nedeltchev; Carlo W Cereda; Georg Kägi; Manuel Bolognese; Stephan Salmen; Rolf Sturzenegger; Friedrich Medlin; Christian Berger; Susanne Renaud; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Marios Psychogios; Pasquale Mordasini; Jan Gralla; Johannes Kaesmacher; Thomas R Meinel Journal: Ann Neurol Date: 2022-06-10 Impact factor: 11.274