title: Thrombolysis in ischemic stroke without arterial occlusion at presentation.
abstract: OBJECTIVE
  None of the randomized trials of intravenous tissue-type plasminogen activator reported vascular imaging acquired before thrombolysis. Efficacy of tissue-type plasminogen activator in stroke without arterial occlusion on vascular imaging remains unknown and speculative.
  
  
  METHODS
  We performed a retrospective, multicenter study to collect data of patients who presented to participating centers during a 5-year period with ischemic stroke diagnosed by clinical examination and MRI and with imaging evidence of no vascular occlusion. These patients were divided into 2 groups: those who received thrombolytic therapy and those who did not. Primary outcome measure of the study was excellent clinical outcome defined as modified Rankin Scale of 0 to 1 at 90 days from stroke onset. Secondary outcome measures were good clinical outcome (modified Rankin Scale, 0-2) and perfect outcome (modified Rankin Scale, 0). Safety outcome measures were incidence of symptomatic intracerebral hemorrhage and poor outcome (modified Rankin Scale, 4-6).
  
  
  RESULTS
  A total of 256 patients met study criteria, 103 with thrombolysis and 153 without. Logistic regression analysis showed that patients who received thrombolysis had more frequent excellent outcomes with odds ratio of 3.79 (P<0.01). Symptomatic intracerebral hemorrhage was more frequent in thrombolysis group (4.9 versus 0.7%; P=0.04). Thrombolysis led to more frequent excellent outcome in nonlacunar group with odds ratio 4.90 (P<0.01) and more frequent perfect outcome in lacunar group with odds ratio 8.25 (P<0.01).
  
  
  CONCLUSIONS
  This study provides crucial data that patients with ischemic stroke who do not have visible arterial occlusion at presentation may benefit from thrombolysis.
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.). dr.s.lahoti@gmail.com.
authors: Sourabh
authors: S
authors: Lahoti
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Sankalp
authors: S
authors: Gokhale
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Louis
authors: L
authors: Caplan
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Patrik
authors: P
authors: Michel
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Yves
authors: Y
authors: Samson
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Charlotte
authors: C
authors: Rosso
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Kaustubh
authors: K
authors: Limaye
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Archana
authors: A
authors: Hinduja
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Aneesh
authors: A
authors: Singhal
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Syed
authors: S
authors: Ali
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Luther Creed
authors: LC
authors: Pettigrew
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Richard
authors: R
authors: Kryscio
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Nikita
authors: N
authors: Dedhia
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: Shirish
authors: S
authors: Hastak
authors: From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.).
authors: David S
authors: DS
authors: Liebeskind
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D002545:Brain Ischemia / Q000628:therapy*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007391:International Cooperation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: magnetic resonance imaging; stroke, lacunar; thrombolytic therapy; tissue-type plasminogen activator