Comparison between MRI screening and CT-plus-MRI screening for thrombolysis within 3 h of ischemic stroke.
OBJECTIVE
Although MRI may provide much information on brain pathology to aid in patient selection for thrombolysis, the concern remains that MRI screening may increase time-to-treatment. We hypothesized that CT-plus-MRI screening might be a valuable time-efficient alternative for selection of patients requiring thrombolysis.


METHODS
We reviewed acute stroke patients who received intravenous tissue plasminogen activator (tPA) (with or without intra-arterial urokinase) initiated within 3 h of stroke between March 2004 and March 2007. MRI was the routine screening imaging employed until November 2005. Thereafter, CT-plus-MRI screening was performed; tPA of 0.6 mg/kg was infused intravenously after exclusion of hemorrhage by CT screening, and subsequently a further decision on thrombolysis (i.e., intravenous tPA of 0.3 mg/kg, or intra-arterial urokinase) was made after MRI screening. We compared times-to-treatment and clinical outcomes between MRI screening and CT-plus-MRI-screening groups, and identified factors associated with good clinical outcome (modified Rankin Scale < or =2 at 3 months).


RESULTS
Eighty-nine patients were included in the analysis; 43 were MRI-screened, and 46 were CT-plus-MRI-screened. Although the MRI-screening group had a longer door-to-needle time (p<0.001), these patients showed better 3-month outcomes compared to CT-plus-MRI-screening group (p=0.01). Multivariate analysis showed that MRI screening (odds ratio 3.97, 95% confidence interval 1.30-12.17, p=0.02) was independently associated with a good outcome at 3 months. In CT-plus-MRI-screening group, although time-to-initial imaging and time-to-tPA were shorter, time-to-MRI and time-to-additional thrombolysis were delayed.


CONCLUSIONS
These results suggest that early patient selection using MRI may be more effective than reduction of times-to-treatment in improvement of thrombolytic outcomes.
Yoo
Sung-Hee
SH
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
Kwon
Sun U
SU
Lee
Deok-Hee
DH
Kim
Sang-Joon
SJ
Kim
Jong S
JS
Kang
Dong-Wha
DW
D000208:Acute Disease; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator