title: Utility of Computed Tomographic Perfusion in Thrombolysis for Minor Stroke.
abstract: OBJECTIVE
  The use of thrombolysis in acute minor ischemic stroke (MIS) remains controversial. We sought to determine the safety and efficacy of intravenous tissue-type plasminogen activator (IV-tPA) in acute MIS patients with demonstrable penumbra on computed tomographic perfusion study.
  
  
  METHODS
  Consecutive MIS patients with National Institutes of Health Stroke Scale ≤3 were identified from a prospective single tertiary-center database over a 4.5-year period (2011-2015). Cases with demonstrable penumbra were analyzed according to treatment received: IV-tPA versus standard stroke-unit care without thrombolysis.
  
  
  RESULTS
  Seventy-three patients of 195 acute MIS admissions had a demonstrable penumbra (34 IV-tPA versus 39 standard stroke-unit care). Overall median National Institutes of Health Stroke Scale and premorbid modified Rankin Scale were 2 and 0, respectively. Median age was 73.2 (interquartile range, 67.3-82.8) years. There were no differences in baseline demographics, risk factors, stroke localization and cause, rates of vascular occlusion (38.2% versus 38.5%; P=1.000), or mean penumbral volume (41.3 versus 25.1 mL; P=0.150; IV-tPA versus standard stroke-unit care) between groups. There were no symptomatic intracerebral hemorrhages in either group. Patients treated with IV-tPA were more likely to have an excellent functional outcome at discharge (88.2% versus 53.9%; P=0.002) and 90 days (91.2% versus 71.8%; P=0.042). Ordinal analysis demonstrated a favorable shift in modified Rankin Scale with IV-tPA both at discharge (odds ratio, 5.23; 95% confidence interval, 1.83-12.20) and 90 days (odds ratio, 4.35; 95% confidence interval, 1.77-11.36).
  
  
  CONCLUSIONS
  In selected MIS patients with demonstrable penumbra on computed tomographic perfusion, IV-tPA is safe and associated with significant improvement in functional outcome at discharge and 90 days.
authors.affiliation: From the Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia (F.C.N., S.C., T.F., C.B., P.M.C.); and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia (C.B., P.M.C.). Ng.fcffelix@gmail.com.
authors.forename: Felix C
authors.initials: FC
authors.lastname: Ng
authors.affiliation: From the Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia (F.C.N., S.C., T.F., C.B., P.M.C.); and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia (C.B., P.M.C.).
authors.forename: Skye
authors.initials: S
authors.lastname: Coote
authors.affiliation: From the Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia (F.C.N., S.C., T.F., C.B., P.M.C.); and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia (C.B., P.M.C.).
authors.forename: Tanya
authors.initials: T
authors.lastname: Frost
authors.affiliation: From the Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia (F.C.N., S.C., T.F., C.B., P.M.C.); and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia (C.B., P.M.C.).
authors.forename: Chris
authors.initials: C
authors.lastname: Bladin
authors.affiliation: From the Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia (F.C.N., S.C., T.F., C.B., P.M.C.); and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia (C.B., P.M.C.).
authors.forename: Philip M
authors.initials: PM
authors.lastname: Choi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: cerebrovascular disorders; intracranial embolism; perfusion; stroke; thrombosis; tissue-type plasminogen activator