title: MRI screening before standard tissue plasminogen activator therapy is feasible and safe.
abstract: OBJECTIVE
  MRI screening for thrombolytic therapy may improve patient selection. Alternatively, it may excessively delay treatment and thereby lead to worse outcomes. We hypothesized that times to treatment and outcomes in a stroke center with immediate MRI access and interpretation would not differ from those of the typical clinical practice.
  
  
  METHODS
  We compared the results of 120 consecutive patients treated with intravenous tissue plasminogen activator (tPA) within 3 hours of onset at our center with those of the 2 largest multicenter registries of tPA use. In addition to standard criteria, MRI specific eligibility criteria were applied in 97 patients. MRI was not performed in 23 patients because of contraindications to MRI or late patient arrival (>2.5 hours). Outcomes were the modified Rankin Scale (mRS) obtained at 3 months.
  
  
  RESULTS
  Times to treatment (median door-to-needle time 81.5 minutes; median onset-to-needle time 135 minutes) and outcomes (mRS 0 to 1, 40.8%; mRS 0 to 2, 47.5%) were not inferior to those of the typical clinical practice. Door-to-needle time was shorter in computed tomography (CT) screening (67.5+/-22.5 minutes; n=23) than in MRI screening (86.8+/-21.5 minutes; n=97; P<0.001). However, outcomes were not different between MRI screening (mRS 0 to 1, 42.3%; mRS 0 to 2, 49.5%) and CT screening (mRS 0 to 1, 34.8%; mRS 0 to 2, 39.1%). Neither times to treatment nor MRI screening was predictive of outcomes.
  
  
  CONCLUSIONS
  These data demonstrate that MRI screening before tPA therapy is feasible and not associated with unacceptable times to treatment or outcomes.
authors.affiliation: National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892-1063, USA.
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chalela
authors.forename: William
authors.initials: W
authors.lastname: Dunn
authors.forename: Steven
authors.initials: S
authors.lastname: Warach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator