title: Intravenous recombinant tissue plasminogen activator improves arterial recanalization rates and reduces infarct volumes in patients with hyperdense artery sign on baseline computed tomography.
abstract: BACKGROUND
  We sought to evaluate arterial recanalization as measured by changes in the presence of hyperdense artery sign (HAS) on initial and 24-hour computed tomography scans in patients treated with recombinant tissue plasminogen activator (rt-PA) or placebo, and to assess the effect of rt-PA on patient outcomes in this population.
  
  
  METHODS
  Patients in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial composed the study group. We determined the percentage of patients with HAS in rt-PA- and placebo-treated groups who had persistence (HAS +/+) or resolution (HAS +/-) of HAS on 24-hour computed tomography, and compared outcomes in those with resolution or persistence of the sign in these treatment groups.
  
  
  RESULTS
  Baseline HAS occurred in 79 of 604 eligible patients (13%). The two treatment groups were similar, although patients treated with rt-PA were significantly older. Of the 79 patients with HAS on baseline computed tomography scan, 14 of 37 (38%) treated with rt-PA had resolution of HAS at 24 hours compared with 7 of 42 (17%) treated with placebo (P = .03). Infarct volumes at 24 hours were significantly smaller in patients treated with rt-PA with resolution of the sign, compared with those who had persistence of the sign (P = .004). In our analysis, functional outcomes were not significantly improved based on resolution of HAS in either treatment group. There were 4 symptomatic ICHs in the rt-PA-treated group with HAS as compared with two in the placebo-treated group.
  
  
  CONCLUSIONS
  Among patients with HAS at baseline in the NINDS rt-PA Stroke Trial, intravenous rt-PA increased recanalization as measured by resolution of HAS and reduced infarct volumes at 24 hours.
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA.cwnich@gmail.com
authors.forename: Christopher
authors.initials: C
authors.lastname: Nichols
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: Thomas
authors.initials: T
authors.lastname: Brott
authors.forename: Joseph
authors.initials: J
authors.lastname: Broderick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator