Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke
BackgroundOver 50% of acute ischemic stroke (AIS) patients present with minor neurological deficits, and optimal treatment is still debated. The randomized PRISMS trial did not show beneficial effects of intravenous thrombolysis (IVT) in unselected patients with minor stroke and non-disabling neurol...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1284058/full |
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| author | Jennifer Sartor-Pfeiffer Jennifer Sartor-Pfeiffer Mirjam Lingel Mirjam Lingel Maria-Ioanna Stefanou Maria-Ioanna Stefanou Markus Krumbholz Markus Krumbholz Markus Krumbholz Markus Krumbholz Florian Hennersdorf Ulrike Ernemann Sven Poli Sven Poli Katharina Feil Katharina Feil Ulf Ziemann Ulf Ziemann Annerose Mengel Annerose Mengel |
| author_facet | Jennifer Sartor-Pfeiffer Jennifer Sartor-Pfeiffer Mirjam Lingel Mirjam Lingel Maria-Ioanna Stefanou Maria-Ioanna Stefanou Markus Krumbholz Markus Krumbholz Markus Krumbholz Markus Krumbholz Florian Hennersdorf Ulrike Ernemann Sven Poli Sven Poli Katharina Feil Katharina Feil Ulf Ziemann Ulf Ziemann Annerose Mengel Annerose Mengel |
| author_sort | Jennifer Sartor-Pfeiffer |
| collection | DOAJ |
| description | BackgroundOver 50% of acute ischemic stroke (AIS) patients present with minor neurological deficits, and optimal treatment is still debated. The randomized PRISMS trial did not show beneficial effects of intravenous thrombolysis (IVT) in unselected patients with minor stroke and non-disabling neurological deficits.PurposeThe study aimed to evaluate if AIS patients with minor stroke may benefit from computed-tomography-perfusion (CTP)-guided IVT. The primary endpoint was good functional outcomes, defined as a modified Rankin Scale score of 0–2 at 90 days.MethodsAIS patients with a NIHSS of ≤5 presenting within 4.5 h underwent multimodal CT-imaging including CTP. CTP mismatch was defined as hypoperfusion on CTP with time-to-peak delay >6 s without corresponding hypoperfusion in cerebral blood volume. IVT decision was left to the attending stroke physicians. Patients with large vessel occlusion (LVO) and absolute contraindications to IVT were excluded.ResultsIn total, 267 consecutive patients were included [mean age: 72 ± 14 years, 45.3% female patients, 75.3% received IVT, median NIHSS on admission: 3 (IQR 2, 4)]. CTP mismatch was detected in 41.8% of IVT− treated patients (IVT+) and 28.8% of standard treatment patients (IVT−) (p = 0.06). IVT+ had favorable outcomes at 90 days compared to IVT− (p = 0.006), but no interaction with an existing CTP mismatch was detected (ORadj: 1.676; 95% CI: 0.644–4.364). No symptomatic intracranial hemorrhage according to ECASS-III criteria occurred.ConclusionAlthough selected AIS patients with minor stroke may benefit from IVT, CTP mismatch does not correlate with functional outcomes. No benefit from CTP mismatch in guiding IVT was detected in patients without LVO presenting with minor neurological deficits. |
| first_indexed | 2024-03-09T14:45:37Z |
| format | Article |
| id | doaj.art-a830033ca7914780ba5ad9aa402089cc |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-09T14:45:37Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-a830033ca7914780ba5ad9aa402089cc2023-11-27T06:35:42ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-11-011410.3389/fneur.2023.12840581284058Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic strokeJennifer Sartor-Pfeiffer0Jennifer Sartor-Pfeiffer1Mirjam Lingel2Mirjam Lingel3Maria-Ioanna Stefanou4Maria-Ioanna Stefanou5Markus Krumbholz6Markus Krumbholz7Markus Krumbholz8Markus Krumbholz9Florian Hennersdorf10Ulrike Ernemann11Sven Poli12Sven Poli13Katharina Feil14Katharina Feil15Ulf Ziemann16Ulf Ziemann17Annerose Mengel18Annerose Mengel19Department of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Pain Treatment, MS Center, Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, GermanyFaculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyDepartment of Neurology and Stroke, University of Tübingen, Tübingen, GermanyHertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, GermanyBackgroundOver 50% of acute ischemic stroke (AIS) patients present with minor neurological deficits, and optimal treatment is still debated. The randomized PRISMS trial did not show beneficial effects of intravenous thrombolysis (IVT) in unselected patients with minor stroke and non-disabling neurological deficits.PurposeThe study aimed to evaluate if AIS patients with minor stroke may benefit from computed-tomography-perfusion (CTP)-guided IVT. The primary endpoint was good functional outcomes, defined as a modified Rankin Scale score of 0–2 at 90 days.MethodsAIS patients with a NIHSS of ≤5 presenting within 4.5 h underwent multimodal CT-imaging including CTP. CTP mismatch was defined as hypoperfusion on CTP with time-to-peak delay >6 s without corresponding hypoperfusion in cerebral blood volume. IVT decision was left to the attending stroke physicians. Patients with large vessel occlusion (LVO) and absolute contraindications to IVT were excluded.ResultsIn total, 267 consecutive patients were included [mean age: 72 ± 14 years, 45.3% female patients, 75.3% received IVT, median NIHSS on admission: 3 (IQR 2, 4)]. CTP mismatch was detected in 41.8% of IVT− treated patients (IVT+) and 28.8% of standard treatment patients (IVT−) (p = 0.06). IVT+ had favorable outcomes at 90 days compared to IVT− (p = 0.006), but no interaction with an existing CTP mismatch was detected (ORadj: 1.676; 95% CI: 0.644–4.364). No symptomatic intracranial hemorrhage according to ECASS-III criteria occurred.ConclusionAlthough selected AIS patients with minor stroke may benefit from IVT, CTP mismatch does not correlate with functional outcomes. No benefit from CTP mismatch in guiding IVT was detected in patients without LVO presenting with minor neurological deficits.https://www.frontiersin.org/articles/10.3389/fneur.2023.1284058/fullminor strokeischemic strokecomputed tomography perfusionintravenous thrombolysisimaging |
| spellingShingle | Jennifer Sartor-Pfeiffer Jennifer Sartor-Pfeiffer Mirjam Lingel Mirjam Lingel Maria-Ioanna Stefanou Maria-Ioanna Stefanou Markus Krumbholz Markus Krumbholz Markus Krumbholz Markus Krumbholz Florian Hennersdorf Ulrike Ernemann Sven Poli Sven Poli Katharina Feil Katharina Feil Ulf Ziemann Ulf Ziemann Annerose Mengel Annerose Mengel Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke Frontiers in Neurology minor stroke ischemic stroke computed tomography perfusion intravenous thrombolysis imaging |
| title | Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke |
| title_full | Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke |
| title_fullStr | Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke |
| title_full_unstemmed | Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke |
| title_short | Computed tomography perfusion imaging-guided intravenous thrombolysis in acute minor ischemic stroke |
| title_sort | computed tomography perfusion imaging guided intravenous thrombolysis in acute minor ischemic stroke |
| topic | minor stroke ischemic stroke computed tomography perfusion intravenous thrombolysis imaging |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1284058/full |
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