title: Multimodal CT-assisted thrombolysis in patients with acute stroke: a cohort study.
abstract: OBJECTIVE
  The value of multimodal CT to assist thrombolysis has received little attention in stroke.
  
  
  METHODS
  We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005-2009).
  
  
  RESULTS
  Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50-5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68-11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80-2.16; interaction test P=0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups.
  
  
  CONCLUSIONS
  Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings.
authors.affiliation: Unit of Cerebrovascular Diseases, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Obach
authors.forename: Laura
authors.initials: L
authors.lastname: Oleaga
authors.forename: Xabier
authors.initials: X
authors.lastname: Urra
authors.forename: Juan
authors.initials: J
authors.lastname: Macho
authors.forename: Sergio
authors.initials: S
authors.lastname: Amaro
authors.forename: Sebastian
authors.initials: S
authors.lastname: Capurro
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomez-Choco
authors.forename: Luís
authors.initials: L
authors.lastname: San Román
authors.forename: Alvaro
authors.initials: A
authors.lastname: Cervera
authors.forename: Jordi
authors.initials: J
authors.lastname: Blasco
authors.forename: Martha
authors.initials: M
authors.lastname: Vargas
authors.forename: Ferrán
authors.initials: F
authors.lastname: Torres
authors.forename: Ángel
authors.initials: Á
authors.lastname: Chamorro
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator