title: [Perfusion computed tomography makes it possible to overcome important SITS-MOST exclusion criteria for the endovenous thrombolysis of cerebral infarction].
abstract: AIM. To study the frequency, safety and efficacy of perfusion computed tomography (PCT), through identification of brain tissue-at-risk, to guide intravenous thrombolysis in stroke patients with regulatory exclusion criteria (SITS-MOST and ECASS-3). PATIENTS AND METHODS. We studied consecutive acute non-lacunar ischemic stroke patients. After conventional CT was considered eligible, PCT was performed in the following circumstances: 4.5 to 6 h window, wake-up stroke or unknown time of onset; extent early infarct signs on CT; minor or severe stroke; seizures or loss of consciousness. Intravenous 0.9 mg/kg alteplase was indicated if: cerebral blood volume lesion covered < 1/3 of middle cerebral artery territory; mismatch > 20% between mean transit time and cerebral blood volume maps existed; and informed consent. SITS-MOST safety-efficacy parameters were used as endpoint variables. RESULTS. Between May 2009-April 2010, 66 hyperacute ischemic stroke patients a priori not eligible for intravenous thrombolysis underwent PCT. Indications were: > 4.5 h in 18 patients, wake up stroke or unknown onset in 25, extent infarct signs in 6, seizures at onset in 11, and minor stroke (NIHSS < 4) in 6. Twenty-nine (44%) of them finally received intravenous thrombolysis. Symptomatic hemorrhagic transformation occurred in 2 (6.9%) patient and 18 (62.1%) achieved a modified Rankin scale score equal or less than 2 on day 90. CONCLUSION. A high proportion of acute stroke patients with SITS-MOST and ECASS-3 exclusion criteria can be safely and efficaciously treated with intravenous thrombolysis using a PCT selection protocol. However randomized control trials will be needed to confirm our results.
authors.affiliation: Hospital Clinico Universitario de Valladolid, Espana. elicortigar@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Cortijo
authors.forename: A I
authors.initials: AI
authors.lastname: Calleja
authors.forename: P
authors.initials: P
authors.lastname: Garcia-Bermejo
authors.forename: S
authors.initials: S
authors.lastname: Perez-Fernandez
authors.forename: J M
authors.initials: JM
authors.lastname: Del Monte
authors.forename: N
authors.initials: N
authors.lastname: Tellez
authors.forename: D M
authors.initials: DM
authors.lastname: Campos-Blanco
authors.forename: M A
authors.initials: MA
authors.lastname: Garcia-Porrero
authors.forename: M R
authors.initials: MR
authors.lastname: Fernandez-Herranz
authors.forename: J F
authors.initials: JF
authors.lastname: Arenillas-Lara
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*