Does clinical-CT 'mismatch' predict early response to treatment with recombinant tissue plasminogen activator?
BACKGROUND
We hypothesized that patients with clinically severe strokes but less severe early ischemic changes on brain CT (i.e., clinical-CT mismatch) may respond better to intravenous recombinant tissue plasminogen activator (i.v. rt-PA) within 3 h of symptom onset.


METHODS
In this secondary analysis of the CLOTBUST data, patients with middle cerebral artery occlusions on transcranial Doppler (TCD) were treated with i.v. rt-PA. Alberta Stroke Program Early CT Scores were obtained with raters blinded to the NIH Stroke Scale and TCD results. Two mismatch criteria and three criteria of response to therapy were explored.


RESULTS
Of 126 patients, 67% had a mismatch type 1 and 74% had a mismatch type 2. The presence of clinical-CT mismatch by either definition did not correlate with any of the three criteria of response to rt-PA. Recanalization was a strong determinant of response, whether or not mismatch was present.


CONCLUSIONS
Mismatch between severity of neurological deficit and CT findings is common but does not predict response to rt-PA therapy given within 3 h.
Choi
John Y
JY
Stroke Program, University of Texas-Houston Medical School, Houston, TX 77030, USA. john.y.choi@uth.tmc.edu
Pary
Jennifer K
JK
Alexandrov
Andrei V
AV
Molina
Carlos A
CA
Garami
Zsolt
Z
Malkoff
Marc D
MD
Rubiera
Marta
M
Shaltoni
Hashem M
HM
Moye
Lemuel A
LA
Grotta
James C
JC
D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D007262:Infusions, Intravenous; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000235:genetics / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator