Macha K, Hölter P, Siedler G, Knott M, Schwab S, Dörfler A, Kallmünzer B, Engelhorn T (2020)
Publication Type: Journal article
Publication year: 2020
Book Volume: 95
Pages Range: e2954-e2964
Journal Issue: 22
DOI: 10.1212/WNL.0000000000011059
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.
APA:
Macha, K., Hölter, P., Siedler, G., Knott, M., Schwab, S., Dörfler, A.,... Engelhorn, T. (2020). Multimodal CT or MRI for IV thrombolysis in ischemic stroke with unknown time of onset. Neurology, 95(22), e2954-e2964. https://doi.org/10.1212/WNL.0000000000011059
MLA:
Macha, Kosmas, et al. "Multimodal CT or MRI for IV thrombolysis in ischemic stroke with unknown time of onset." Neurology 95.22 (2020): e2954-e2964.
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