title: Routine 24-Hour Computed Tomography Brain Scan is not useful in stable patients Post Intravenous Tissue Plasminogen Activator.
abstract: BACKGROUND
  Obtaining a routine computed tomography (CT) brain scan 24 hours after treatment with intravenous tissue plasminogen activator (IV-tPA) is included in the American Heart Association/American Stroke Association acute stroke guidelines. The usefulness of the test in stable patients is not known. We hypothesized that the results of routine, 24-hour post-treatment neuroimaging (CT or magnetic resonance imaging [MRI] brain scans) would not alter the management of clinically stable patients.
  
  
  METHODS
  Patients treated with IV-tPA between January 2011 and December 2013 were identified from a single hospital's stroke registry. All patients were closely monitored for changes in stroke severity. Demographics, changes in neurological status, neuroimaging results, and changes in therapy were abstracted from the patients' medical records. Patients having a neuroimaging study because of neurological deterioration were excluded.
  
  
  RESULTS
  Of 136 patients treated with IV-tPA, 131 met criteria for inclusion. Of these, 86.7% had moderate to severe neurological deficits (i.e., initial National Institutes of Health Stroke Scale score > 5 points; median 8 points). All patients had routine imaging ~24 hours after treatment (CT brain 62.6%, MRI brain 12.4%, both CT and MRI brain 25%). Asymptomatic hemorrhagic transformation occurred in 6.7% and potentially changed management in a single patient (target systolic blood pressure was lowered from 185 to 180 mmHg).
  
  
  CONCLUSIONS
  Over a 3-year period, routine neuroimaging ~24-hours after IV-tPA in clinically stable patients was associated with a change in therapy in only 1 (.95%) patient. If confirmed in other cohorts, these results suggest that routine neuroimaging after IV-tPA may be safely avoided in clinically stable patients, eliminating unnecessary radiation exposure in those having CT brain and reducing costs.
authors.affiliation: Department of Neurology, Duke University Medical Center, Durham, NC, United States. Electronic address: Mary.Guhwe@dm.duke.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Guhwe
authors.affiliation: Duke University School of Nursing, Durham, NC, United States.
authors.forename: Queen
authors.initials: Q
authors.lastname: Utley-Smith
authors.affiliation: Department of Neurology, Duke University Medical Center, Durham, NC, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Blessing
authors.affiliation: Department of Neurology and Kentucky Neuroscience Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000187:drug effects; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: IV-tPA; Stroke; brain CT; brain MRI; emergency treatment of stroke; hemorrhagic transformation; stroke diagnostic imaging; stroke guidelines