title: IV t-PA influences infarct volume in minor stroke: a pilot study.
abstract: BACKGROUND
  There is an ongoing debate whether stroke patients presenting with minor or moderate symptoms benefit from thrombolysis. Up until now, stroke severity on admission is typically measured with the NIHSS, and subsequently used for treatment decision.
  
  
  OBJECTIVE
  Acute MRI lesion volume assessment can aid in therapy decision for iv-tPA in minor stroke.
  
  
  METHODS
  We analysed 164 patients with NIHSS 0-7 from a prospective stroke MRI registry, the 1000+ study (clinicaltrials.org NCT00715533). Patients were examined in a 3 T MRI scanner and either received (n = 62) or did not receive thrombolysis (n = 102). DWI (diffusion weighted imaging) and PI (perfusion imaging) at admission were evaluated for diffusion - perfusion mismatch. Our primary outcome parameter was final lesion volume, defined by lesion volume on day 6 FLAIR images.
  
  
  RESULTS
  The association between t-PA and FLAIR lesion volume on day 6 was significantly different for patients with smaller DWI volume compared to patients with larger DWI volume (interaction between DWI and t-PA: p = 0.021). Baseline DWI lesion volume was dichotomized at the median (0.7 ml): final lesion volume at day 6 was larger in patients with large baseline DWI volumes without t-PA treatment (median difference 3, IQR -0.4-9.3 ml). Conversely, in patients with larger baseline DWI volumes final lesion volumes were smaller after t-PA treatment (median difference 0, IQR -4.1-5 ml). However, this did not translate into a significant difference in the mRS at day 90 (p = 0.577).
  
  
  CONCLUSIONS
  Though this study is only hypothesis generating considering the number of cases, we believe that the size of DWI lesion volume may support therapy decision in patients with minor stroke.
  
  
  BACKGROUND
  Clinicaltrials.org NCT00715533.
authors.affiliation: Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Charité, Berlin, Germany.
authors.forename: Kersten
authors.initials: K
authors.lastname: Villringer
authors.affiliation: Department for Biostatistics and Clinical Epidemiology and Center for Stroke Research, Charité, Berlin, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.affiliation: Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Charité, Berlin, Germany.
authors.forename: Lars-Arne
authors.initials: LA
authors.lastname: Schaafs
authors.affiliation: Department of Neurology and Center for Stroke Research, Charité, Berlin, Germany.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.affiliation: Department of Neurology and Center for Stroke Research, Charité, Berlin, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Audebert
authors.affiliation: Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Charité, Berlin, Germany.
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000473:pathology; D020520:Brain Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator