title: Acute stroke: usefulness of early CT findings before thrombolytic therapy.
abstract: OBJECTIVE
  To determine whether the extent of subtle parenchymal hypoattenuation detected on computed tomographic (CT) scans obtained within 6 hours of ischemic stroke is a factor in predicting patients' response to thrombolytic treatment.
  
  
  METHODS
  The baseline CT scans of 620 patients, who received either recombinant tissue plasminogen activator (rt-PA) or a placebo, in a double-blind, randomized multicenter trial were prospectively evaluated and assigned to one of three categories according to the extent of parenchymal hypoattenuation: none, 33% or less (small), or more than 33% (large) of the middle cerebral artery territory. The association between the extent of hypoattenuation on the baseline CT scans and the clinical outcome in the placebo-treated and the rt-PA-treated groups after 3 months was analyzed.
  
  
  RESULTS
  In 215 patients with a small hypoattenuating area, treatment increased the chance of good outcome. In 336 patients with a normal CT scan and in 52 patients with a large hypoattenuating area, rt-PA had no beneficial effect but increased the risk for fatal brain hemorrhage.
  
  
  CONCLUSIONS
  The response to rt-PA in patients with ischemic stroke can be predicted on the basis of initial CT findings of the extent of parenchymal hypoattenuation in the territory of the middle cerebral artery.
authors.affiliation: Department of Neuroradiology, Technische Universität, Dresden, Germany.
authors.forename: R
authors.initials: R
authors.lastname: von Kummer
authors.forename: K L
authors.initials: KL
authors.lastname: Allen
authors.forename: R
authors.initials: R
authors.lastname: Holle
authors.forename: L
authors.initials: L
authors.lastname: Bozzao
authors.forename: S
authors.initials: S
authors.lastname: Bastianello
authors.forename: C
authors.initials: C
authors.lastname: Manelfe
authors.forename: E
authors.initials: E
authors.lastname: Bluhmki
authors.forename: P
authors.initials: P
authors.lastname: Ringleb
authors.forename: D H
authors.initials: DH
authors.lastname: Meier
authors.forename: W
authors.initials: W
authors.lastname: Hacke
mesh_terms: D000208:Acute Disease; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator