title: Can baseline magnetic resonance angiography (MRA) status become a foremost factor in selecting optimal acute stroke patients for recombinant tissue plasminogen activator (rt-PA) thrombolysis beyond 3 hours?
abstract: OBJECTIVE
  We investigated whether baseline vessel status evaluated by magnetic resonance angiography (MRA) can be the foremost factor to classify acute ischemic stroke patients into subgroups for thrombolytic therapy within 3-6 hours of symptom onset.
  
  
  METHODS
  Acute ischemic stroke patients beyond 3 hours after symptom onset were examined by stroke magnetic resonance imaging (MRI) (diffusion- and perfusion-weighted imaging, and MRA) before and after thrombolysis treatment within 24-48 hours. Stroke MRI was used to classify acute ischemic stroke patients into subgroups and select optimal patients for thrombolytic treatment. Clinical scores were compared to determine whether there were significant differences among subgroups.
  
  
  RESULTS
  The difference in day 90 modified Rankin scale (mRS) between treated salvageable and untreated salvageable patients with recombinant tissue plasminogen activator (rt-PA) was remarkably statistically significant (p=0.02). Treated salvageable patients had more favorable clinical outcomes as compared with the untreated salvageable patients. Patients who did not have baseline artery occlusion were associated with more favorable clinical outcomes than untreated salvageable patients (p<0.001). The difference between treated salvageable and patients without artery occlusion in 90 day mRS score was not statistically significant (p=0.058).
  
  
  CONCLUSIONS
  Baseline vessel status evaluated by MRA may be used as the first factor ahead of mismatch to categorize acute ischemic stroke patients into subgroups. Patients who do not have initial vessel occlusion may not need thrombolytic therapy.
authors.affiliation: Department of Neuroradiology, Capital Medical University, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.forename: Pei-Yi
authors.initials: PY
authors.lastname: Gao
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.forename: Jing
authors.initials: J
authors.lastname: Xue
authors.forename: Xiao-Chun
authors.initials: XC
authors.lastname: Wang
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Wang
authors.forename: Yi-Long
authors.initials: YL
authors.lastname: Wang
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Liao
authors.forename: Mei-Li
authors.initials: ML
authors.lastname: Liu
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Cui
authors.forename: Lan
authors.initials: L
authors.lastname: Yu
authors.forename: Sui-Jun
authors.initials: SJ
authors.lastname: Tong
authors.forename: Yuan-Liang
authors.initials: YL
authors.lastname: Huang
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055420:Perfusion Imaging / Q000379:methods; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator