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Critical Care and Emergency Medicine - Neurological Disorders - Radiology and Medical Imaging

Safety and Clinical Outcome of Thrombolysis in Ischaemic Stroke Using a Perfusion CT Mismatch between 3 and 6 Hours
Published: Monday, October 10, 2011
Author: Laszlo K. Sztriha et al.

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.


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.


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.


The use of a CTP mismatch model may help to guide thrombolysis decisions up to 6 h after IS onset.