Prevalence of Imaging Targets in Patients With Minor Stroke Selected for IV tPA Treatment Using MRI: The Treatment of Minor Stroke With MRI Evaluation Study (TIMES).

MedStar author(s):
Citation: Neurology. 96(9):e1301-e1311, 2021 03 02.PMID: 33472921Institution: MedStar Washington Hospital CenterDepartment: NeurologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Ischemic Stroke/dg [Diagnostic Imaging] | *Ischemic Stroke/dt [Drug Therapy] | *Magnetic Resonance Imaging/mt [Methods] | *Plasminogen Activators/tu [Therapeutic Use] | *Tissue Plasminogen Activator/tu [Therapeutic Use] | Aged | Aged, 80 and over | Cohort Studies | Disability Evaluation | Female | Humans | Image Processing, Computer-Assisted | Injections, Intravenous | Male | Middle Aged | Plasminogen Activators/ad [Administration & Dosage] | Recovery of Function | Time-to-Treatment | Tissue Plasminogen Activator/ad [Administration & Dosage] | Treatment OutcomeYear: 2021Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0028-3878
Name of journal: NeurologyAbstract: CONCLUSIONS: In MRI-screened mAIS, imaging targets were more frequently seen in patients treated with IV tPA, with similar frequencies even in those without clearly-disabling deficits. MRI targets could be used to guide thrombolytic therapy in mAIS patients; however, a randomized trial is needed to demonstrate efficacy. Copyright (c) 2021 American Academy of Neurology.METHODS: Patients with ischemic stroke from 2015-2017 with admit NIHSS<6 were considered. The Treated cohort: 1) received standard IV tPA, and 2) screened with baseline MRI. The Untreated cohort received: 1) no acute intervention, and 2) baseline MRI <4 hours from onset. Patients were stratified into "clearly" and "not clearly" disabling deficits by NIHSS elements. Baseline MRI was evaluated by independent raters for AIS targets, with frequencies compared between groups.OBJECTIVE: To determine the IV tPA treatment rate of minor acute ischemic stroke (mAIS) patients at our centers and compare the frequency of MRI targets by treatment stratification and clinical severity, we evaluated clinical characteristics and baseline MRIs for tPA-treated and untreated patients.RESULTS: Of 255 mAIS patients <=4.5 hours from onset, 140 (55%) received IV tPA, accounting for 46% of all IV tPA patients (n=305). Eighty-five percent (n=119) were screened with baseline MRI and had significantly more frequent imaging targets compared to those untreated (n=90). Of this treated cohort, 75% (n=89) were not clearly-disabling. Except for perfusion-diffusion mismatch (81% clearly-disabling versus 56% not clearly-disabling (p=0.036)), there were no significant differences in the frequency of imaging targets across the treated cohort stratified by clinical severity.All authors: Benson RT, Burton SP, Hsia AW, Kalaria C, Latour L, Leigh R, Luby ML, Lynch JK, Nadareishvili ZOriginally published: Neurology. 2021 01 20Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2021-02-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 33472921 Available 33472921

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: In MRI-screened mAIS, imaging targets were more frequently seen in patients treated with IV tPA, with similar frequencies even in those without clearly-disabling deficits. MRI targets could be used to guide thrombolytic therapy in mAIS patients; however, a randomized trial is needed to demonstrate efficacy. Copyright (c) 2021 American Academy of Neurology.

METHODS: Patients with ischemic stroke from 2015-2017 with admit NIHSS<6 were considered. The Treated cohort: 1) received standard IV tPA, and 2) screened with baseline MRI. The Untreated cohort received: 1) no acute intervention, and 2) baseline MRI <4 hours from onset. Patients were stratified into "clearly" and "not clearly" disabling deficits by NIHSS elements. Baseline MRI was evaluated by independent raters for AIS targets, with frequencies compared between groups.

OBJECTIVE: To determine the IV tPA treatment rate of minor acute ischemic stroke (mAIS) patients at our centers and compare the frequency of MRI targets by treatment stratification and clinical severity, we evaluated clinical characteristics and baseline MRIs for tPA-treated and untreated patients.

RESULTS: Of 255 mAIS patients <=4.5 hours from onset, 140 (55%) received IV tPA, accounting for 46% of all IV tPA patients (n=305). Eighty-five percent (n=119) were screened with baseline MRI and had significantly more frequent imaging targets compared to those untreated (n=90). Of this treated cohort, 75% (n=89) were not clearly-disabling. Except for perfusion-diffusion mismatch (81% clearly-disabling versus 56% not clearly-disabling (p=0.036)), there were no significant differences in the frequency of imaging targets across the treated cohort stratified by clinical severity.

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