by Laszlo K. Sztriha, Dulka Manawadu, Jozef Jarosz, Jeff Keep, Lalit Kalra
It may be possible to thrombolyse ischaemic stroke (IS) patients up to 6 h by using penumbral imaging. We investigated whether a perfusion CT (CTP) mismatch can help to select patients for thrombolysis up to 6 h. Methods
A cohort of 254 thrombolysed IS patients was studied. 174 (69%) were thrombolysed at 0–3 h by using non-contrast CT (NCCT), and 80 (31%) at 3–6 h (35 at 3–4.5 h and 45 at 4.5–6 h) by using CTP mismatch criteria. Symptomatic intracerebral haemorrhage (SICH), the mortality and the modified Rankin Score (mRS) were assessed at 3 months. Independent determinants of outcome in patients thrombolysed between 3 and 6 h were identified. Results
The baseline characteristics were comparable in the two groups. There were no differences in SICH (3% v 4%, p?=?0.71), any ICH (7% v 9%, p?=?0.61), or mortality (16% v 9%, p?=?0.15) or mRS 0–2 at 3 months (55% v 54%, p?=?0.96) between patients thrombolysed at 0–3 h (NCCT only) or at 3–6 h (CTP mismatch). There were no significant differences in outcome between patients thrombolysed at 3–4.5 h or 4.5–6 h. The NIHSS score was the only independent determinant of a mRS of 0–2 at 3 months (OR 0.89, 95% CI 0.82–0.97, p?=?0.007) in patients treated using CTP mismatch criteria beyond 3 h. Conclusions
The use of a CTP mismatch model may help to guide thrombolysis decisions up to 6 h after IS onset.