MRI-based thrombolytic therapy in patients with acute ischemic stroke presenting with a low NIHSS.

MedStar author(s):
Citation: Neurology. 93(16):e1507-e1513, 2019 10 15.PMID: 31519779Institution: MedStar Washington Hospital CenterDepartment: NeurologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Brain Ischemia/th [Therapy] | *Magnetic Resonance Imaging | *Stroke/th [Therapy] | *Tissue Plasminogen Activator/tu [Therapeutic Use] | Aged | Aspirin/tu [Therapeutic Use] | Brain Ischemia/di [Diagnosis] | Female | Fibrinolytic Agents/tu [Therapeutic Use] | Humans | Intracranial Hemorrhages/th [Therapy] | Magnetic Resonance Imaging/mt [Methods] | Male | Middle Aged | Stroke/di [Diagnosis] | Thrombolytic Therapy/ae [Adverse Effects]Year: 2019Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0028-3878
Name of journal: NeurologyAbstract: CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with acute ischemic stroke and NIHSS <=5 screened with MRI, IV tissue plasminogen activator is safe. Copyright (c) 2019 American Academy of Neurology.CONCLUSIONS: Thrombolytic therapy was safe in our patients with stroke with minor deficits who were initially evaluated by MRI. Future studies of this population may benefit from MRI selection.METHODS: The NIH Natural History of Stroke database was reviewed from January 2006 to December 2016 to identify all patients with an initial NIHSS score <=5 who received thrombolysis within 4.5 hours of symptom onset after being screened with MRI. The 24-hour postthrombolysis MRIs were reviewed for hemorrhagic transformation. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and favorable 90-day outcome modified Rankin Scale score 0-1. Subgroup analysis was performed on patients who would have been eligible for the PRISMS trial, which enrolled patients with a nondisabling neurologic deficit.OBJECTIVE: Treatment of patients with stroke presenting with minor deficits remains controversial, and the recent Potential of rtPA for Ischemic Strokes with Mild Symptoms (PRISMS) trial, which randomized patients to thrombolysis vs aspirin, did not show benefit. We studied the safety and efficacy of thrombolysis in a population of patients with acute stroke presenting with low NIH Stroke Scale (NIHSS) scores screened using MRI.RESULTS: A total of 121 patients were included in the study with a median age of 65 and an NIHSS score of 3; 63% were women. The rate of any hemorrhagic transformation was 13%, with 11% of them being limited to petechial hemorrhage. The rate of sICH was <1%. Sixty-six patients had 90-day outcome data; of those, 74% had a favorable outcome. For the subgroup of 81 PRISMS-eligible patients, none experienced sICH. Fifty of these patients had 90-day outcome data; of these, 84% had a favorable outcome.All authors: Benson RT, Hsia AW, Kalaria CP, Latour LL, Leigh R, Luby M, Lynch JK, Majidi S, Nadareishvili ZOriginally published: Neurology. 2019 Sep 13Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-10-10
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31519779 Available 31519779

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

CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with acute ischemic stroke and NIHSS <=5 screened with MRI, IV tissue plasminogen activator is safe. Copyright (c) 2019 American Academy of Neurology.

CONCLUSIONS: Thrombolytic therapy was safe in our patients with stroke with minor deficits who were initially evaluated by MRI. Future studies of this population may benefit from MRI selection.

METHODS: The NIH Natural History of Stroke database was reviewed from January 2006 to December 2016 to identify all patients with an initial NIHSS score <=5 who received thrombolysis within 4.5 hours of symptom onset after being screened with MRI. The 24-hour postthrombolysis MRIs were reviewed for hemorrhagic transformation. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and favorable 90-day outcome modified Rankin Scale score 0-1. Subgroup analysis was performed on patients who would have been eligible for the PRISMS trial, which enrolled patients with a nondisabling neurologic deficit.

OBJECTIVE: Treatment of patients with stroke presenting with minor deficits remains controversial, and the recent Potential of rtPA for Ischemic Strokes with Mild Symptoms (PRISMS) trial, which randomized patients to thrombolysis vs aspirin, did not show benefit. We studied the safety and efficacy of thrombolysis in a population of patients with acute stroke presenting with low NIH Stroke Scale (NIHSS) scores screened using MRI.

RESULTS: A total of 121 patients were included in the study with a median age of 65 and an NIHSS score of 3; 63% were women. The rate of any hemorrhagic transformation was 13%, with 11% of them being limited to petechial hemorrhage. The rate of sICH was <1%. Sixty-six patients had 90-day outcome data; of those, 74% had a favorable outcome. For the subgroup of 81 PRISMS-eligible patients, none experienced sICH. Fifty of these patients had 90-day outcome data; of these, 84% had a favorable outcome.

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