Intravenous Thrombolysis for Acute Ischaemic Stroke in Young Adult Patients

Background:Intravenous tissue plasminogen activator (IV tPA) has been studied primarily in patients over age 50. We sought to describe baseline differences in adult patients ≤50 years-old taken from a large prospective cohort of acute stroke patients treated with intravenous tPA (IV tPA) and to determine whether outcomes differed for this population.Methods:Data (n = 1120) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (CASES) were reviewed and patients aged ≤50 years-old (n=99) were compared with those aged >50 years (n=1021) with regards to baseline characteristics, symptomatic intracerebral haemorrhage (sICH), functional outcome at 90 days and death.Results:Nine percent of patients were ≤50 years-old. Among patients aged ≤50 years, 40.4% were women and median age was 42 ± 6.1 years (range 20 to 50). They had significantly more current cigarette use but fewer other vascular risk factors than older patients (p<0.05) and their baseline median NIHSS score was lower (13 versus 15, P=0.001). Although this group was more likely to have a favourable 90-day outcome, multivariable regression confirmed that age ≤50 years, while independently associated with a decreased risk of death (RR 0.36, 95% CI 0.14 to 0.95), was not itself predictive of favourable 90-day outcome or decreased risk of sICH.Conclusions:Adult patients ≤50 years-old had fewer medical co-morbidities and a modestly lower baseline median NIHSS score than their older counterparts. Age ≤50 years was independently associated with a decreased risk of death but not with favourable outcome or risk of sICH.

Download Full-text

Delayed Intravenous Thrombolysis in Patients with Minor Stroke

Cerebrovascular Diseases ◽

10.1159/000492123 ◽

2018 ◽

Vol 46 (1-2) ◽

pp. 52-58 ◽

Cited By ~ 4

Author(s):

Joonsang Yoo ◽

Sung-Il Sohn ◽

Jinkwon Kim ◽

Seong Hwan Ahn ◽

Kijeong Lee ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Stroke Care ◽

Minor Stroke ◽

Acute Stroke Care ◽

Nihss Score ◽

Delayed Treatment ◽

Intravenous Tissue Plasminogen Activator ◽

Stroke Group ◽

Suspected Stroke ◽

Iv Tpa

Background: The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient’s stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA). Methods: We included consecutive patients who received IV tPA during a 1.5 year-period in 5 hospitals. Minor stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score < 5. We compared various intervals from arrival at the ED to treatment between patients with minor stroke and those with non-minor stroke (NIHSS score ≥5). Delayed treatment was defined as a door-to-needle time > 40 min. Results: During the study period, 356 patients received IV tPA treatment. The median door-to-needle time was significantly longer in the minor stroke group than it was in the non-minor stroke group (43 min [interquartile range [IQR] 35.5–55.5] vs. 37 min [IQR 30–46], p < 0.001). The minor stroke group had a significantly longer door-to-notification time (7 min [IQR 4.5–12] vs. 5 min [IQR 3–8], p < 0.001) and door-to-imaging time (20 min [IQR 15–26.5] vs. 16 min [IQR 11–21], p < 0.001) than did the non-minor stroke group. However, the imaging-to-needle time was not different between the groups. Multivariable analyses revealed that minor stroke was associated with delayed treatment (OR 2.54 [95% CI 1.52–4.30], p = 0.001). Conclusions: Our findings show that the door-to-needle time was longer in patients with minor stroke than it was in those with non-minor stroke, mainly owing to delayed action in the initial steps of neurology notification and imaging. Our findings suggest that some quality improvement initiatives are necessary for patients with suspected stroke with minor symptoms.

Download Full-text

Abstract T P211: Continued Participation in a Telestroke Program Improves Time to Intravenous Thrombolysis

Stroke ◽

10.1161/str.46.suppl_1.tp211 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jamal N Muthana ◽

James J Conners ◽

Shawna Cutting ◽

Sarah Y Song ◽

Elizabeth Diebolt ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Stroke Patients ◽

Nihss Score ◽

Period 2 ◽

Intravenous Tissue Plasminogen Activator ◽

Educational Partnership ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Mean Time ◽

Iv Tpa

Background: Improved clinical outcomes after intravenous tissue plasminogen activator (IV tPA) are time dependent. Participation in a telestroke program allows the spoke hospitals 24/7 access to a vascular fellowship trained neurologist for a telestroke consult, as well as educational partnership with the hub site, shared protocols, and access to quality improvement feedback. We sought to assess the effects of continued participation in a telestroke program on times to administration of IV tPA. Methods: Our institutional telestroke program began in March 2011 and consists of an academic hub (comprehensive stroke center) that serves 8 community spoke hospitals. We retrospectively reviewed acute ischemic stroke patients treated with IV tPA via the telestroke program. We compared 2 cohorts of patients: Period 1 (July 2011 to June 2013) and Period 2 (July 2013 to July 2014). We collected data on demographics, National Institutes of Health Stroke Scale (NIHSS), and times from initiation of telestroke consult to IV tPA administration. Results: Among 259 consecutive stroke patients (mean: 69.6 years, 56% female) treated with IV tPA via telestroke, the median NIHSS score was 11.8, and 41.7% of patients were transferred to the hub. The mean time from initiation of telestroke consult to IV tPA administration was 42.2 minutes. Period 1 included 129 patients and Period 2 included 130 patients, and the two groups did not differ by age (p=0.2), gender (p=0.3), or NIHSS score (p=0.3). Time from initiation of telestroke consult to IV tPA administration improved from Period 1 to Period 2 (35 vs. 49.9 minutes, p<0.0001). This improvement was due to faster mean time from initiation of telestroke consult to IV tPA advised (12.5 vs. 17.4 minutes, p<0.0001) and faster mean time from IV tPA advised to administration (22.5 vs. 33.1 minutes, p<0.0001). Conclusions: Maturation of a telestroke program is associated with improvement in the timeliness of IV tPA delivery, possibly due to a learning effect that continues the longer the sites participate in the program. This improvement is due to faster responses in both the hub site (recommending IV tPA earlier) and spoke site (administering IV tPA quicker). Further studies aimed at improving delivery of IV tPA in telestroke program are warranted.

Download Full-text

Abstract 145: Outcome in Patients with Minor Stroke: The Effect of Itemized NIHSS Score Subsets

Stroke ◽

10.1161/str.46.suppl_1.145 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Joshua Z Willey ◽

Howard Andrews ◽

Amelia K Boehme ◽

Leigh Quarles ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Minor Stroke ◽

Motor Deficits ◽

Stroke Severity ◽

Nihss Score ◽

Discharge Disposition ◽

Discharge Home ◽

Dichotomous Variable ◽

Secondary Analyses ◽

Multivariable Regression

Background: The use of the National Insitutes of Health Stroke Scale (NIHSS) to assess stroke severity in minor stroke is controversial. We hypothesized that patients with cortical signs on the itemized NIHSS subsets (neglect, visual, or language) will have a worse outcome than those without. Methods: Data was retrieved from the Columbia SPOTRIAS dataset. All patients with NIHSS between 0 and 5 within 12 hours from symptom onset who were not treated with intravenous thrombolysis were included. Patients were followed prospectively as part of the “Stroke Warning Information and Faster Treatment” Study. Poor outcome was defined as not being discharged home and analyzed using multivariable logistic regression. The primary predictor was cortical features on the itemized NIHSS. Individual components of the NIHSS score, treated as a dichotomous variable, as well as the admission NIHSS score were assessed in secondary analyses. Results: The sample included 894 patients, of which 162 (18%) were not discharged home. In multivariable regression analysis of baseline demographics, risk factors, median NIHSS, and cortical signs, only mean age (OR = 1.02, P<0.001) and NIHSS score (OR = 1.59, p<0.001) were associated with non-discharge home. In secondary analyses having any score on the following items predicted non-discharge home: Motor (OR = 2.40, p<0.001), LOC (OR = 6.67, p=0.004), and Ataxia (OR = 3.21, p<0.001). Other items from the NIHSS were not associated with discharge disposition. Motor deficits (AUC 0.623) appeared to be more predictive of discharge outcome than ataxia (AUC 0.569) and LOC deficits (AUC 0.517). In addition, the admission NIHSS had a fair correlation with discharge outcome (AUC 0.683). Conclusion: Deficits in LOC, motor weakness, and ataxia predict discharge outcome in patients with mild stroke, with the motor score being the most influential component. This may potentially alter treatment decisions in this population. The fair correlation between NIHSS score and discharge outcome suggests that certain factors not captured by the NIHSS score may contribute to discharge outcome in this patient population.

Download Full-text

Abstract 2779: The Safety of Intravenous Thrombolysis for Ischemic Stroke in Patients With Pre-Existing Cerebral Aneurysms: A Retrospective, Hospital-Based Study

Stroke ◽

10.1161/str.43.suppl_1.a2779 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Nancy Edwards ◽

Hooman Kamel ◽

S. Andrew Josephson

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Aneurysms ◽

Intravenous Thrombolysis ◽

Aneurysm Rupture ◽

Exact Test ◽

Intravenous Tissue Plasminogen Activator ◽

Unruptured Cerebral Aneurysms ◽

Risk Of Hemorrhage ◽

Iv Tpa

Background and Purpose: Unruptured cerebral aneurysms are currently considered a contraindication to intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke. This is due to a theoretical increase in the risk of hemorrhage from aneurysm rupture, although it is unknown whether this risk is significant. We sought to determine the safety of IV tPA administration in a cohort of patients with pre-existing aneurysms. Methods: We reviewed the medical records of patients treated for acute ischemic stroke with IV tPA during an 11-year period at two academic medical centers. We identified a subset of patients with unruptured cerebral aneurysms present on pre-thrombolysis vascular imaging. Our outcomes of interest were any intracranial hemorrhage (ICH), symptomatic ICH, and subarachnoid hemorrhage (SAH). Fisher’s exact test was used to compare the rates of hemorrhage among patients with and without aneurysms. Results: We identified 236 eligible patients, of whom 22 had unruptured cerebral aneurysms. The rate of ICH among patients with aneurysms (14%, 95% CI 3-35%) did not significantly differ from the rate among patients without aneurysms (19%, 95% CI 14-25%). None of the patients with aneurysms developed symptomatic ICH (0%, 95% CI 0-15%), compared with 10 of 214 patients without aneurysms (5%, 95% CI 2-8%). Similar proportions of patients developed SAH (5%, 95% CI 0-23% versus 6%, 95% CI 3-10%). Conclusion: Our findings suggest that IV tPA for acute ischemic stroke is safe to administer in patients with pre-existing cerebral aneurysms as the risk of aneurysm rupture and symptomatic ICH is low.

Download Full-text

Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014837 ◽

2019 ◽

Vol 11 (12) ◽

pp. 1187-1190 ◽

Cited By ~ 4

Author(s):

Ameer E Hassan ◽

Hari Kotta ◽

Leeroy Garza ◽

Laurie Preston ◽

Wondwossen Tekle ◽

...

Keyword(s):

Average Length ◽

Length Of Hospital Stay ◽

Functional Independence ◽

Multivariate Statistical ◽

Capture Process ◽

Endovascular Thrombectomy ◽

Nihss Score ◽

Intravenous Tissue Plasminogen Activator ◽

Improved Outcomes ◽

Iv Tpa

ObjectiveTo investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA).MethodsWe retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0–2) were collected. Univariate and multivariate statistical analyses were performed.ResultsOf a total of 254 patients, 96 (37.8%) underwent EVT+IV tPA. Median NIHSS score at admission was significantly higher in the EVT+IV tPA group than in the EVT group (p=0.006). After adjusting for NIHSS admission score, patient bills and encounter charges in the EVT+IV tPA group were still found to be $3861.64 (95% CI $658.84 to $7064.45, p=0.02) and $158 071.29 (95% CI $134 641.50 to $181 501.08, p < 0.001) greater than in the EVT only group respectively. The EVT+IV tPA group had a higher complication rate of intracranial hemorrhage (ICH) (p=0.005). The EVT and EVT+IV tPA groups did not differ significantly in median discharge NIHSS score (p=0.56), functional independence rate at 90 days (p=0.96), or average length of hospital stay (p=0.21).ConclusionPatients treated with EVT+IV tPA have greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo treatment with EVT only.

Download Full-text

Abstract TMP69: Incidence of Intracranial Hemorrhage After Intravenous Thrombolysis in Telestroke

Stroke ◽

10.1161/str.48.suppl_1.tmp69 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nabeel A Herial ◽

Evan M Fitchett ◽

Maureen DePrince ◽

Giuliana Labella ◽

Kimon Bekelis ◽

...

Keyword(s):

Intracranial Hemorrhage ◽

Intravenous Thrombolysis ◽

Study Data ◽

Hemorrhagic Complication ◽

Stroke Outcomes ◽

Intravenous Tissue Plasminogen Activator ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Iv Tpa

Background: Promoting intravenous tissue plasminogen activator (IV tPA) in treating eligible patients with acute ischemic stroke (AIS) is critical in reducing overall stroke burden. Effective telestroke networks are proven to facilitate higher rates of IV tPA use. Increasing data on stroke outcomes continues to emerge with expansion of telestroke services nationwide. Objective: To estimate the incidence of intracranial hemorrhage (ICH) in AIS patients treated with IV tPA via telestroke evaluation. Methods: In this study, data from a large telestroke network comprising 36 hospitals from 3 States and associated with a university-based health system and comprehensive stroke center was utilized. Data included total of 3198 acute telestroke evaluations performed within the network between January 2014 and June 2016. Distance of spoke hospitals from the hub ranged between 2.5 and 125 miles. All telestroke consultations were done using the remote presence robotic technology. 15% of all telestroke evaluations and 51% of post-IV tPA patients were transferred to the hub. CT imaging was used for identification and ICH as defined mainly in the NINDS trial was used for comparison. Results: Mean age of patients was 67 years (sd=16) and majority were women (n=1759, 55%). Average NIHSS score at presentation was 7. IV tPA was administered to 18% of all telestroke patients. Post IV tPA, any ICH (symptomatic or not) was noted in 8.7% of patients. Petechial hemorrhage was most frequently reported finding. Rate of any ICH in our telestroke population was relatively lower compared to the ECASS II (39%, p<0.001), ECASS III (27%, p<0.001), SITS-MOST (9.6%, p=0.63), ATLANTIS (11.4%, p=0.30), and higher than the NINDS (6.4%, p=0.29). Conclusions: Higher rate of IV tPA use and lower rate of hemorrhagic complication observed in this large study further supports and strengthens the role of telestroke technology and expertise in treatment of AIS.

Download Full-text

Initial Stroke Severity Is the Major Outcome Predictor for Patients Who Do Not Receive Intravenous Thrombolysis due to Mild or Rapidly Improving Symptoms

ISRN Neurology ◽

10.5402/2011/947476 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

Mu-Chien Sun ◽

Tien-Bao Lai

Keyword(s):

Independent Predictor ◽

Intravenous Thrombolysis ◽

National Institutes Of Health ◽

Unfavorable Outcome ◽

Stroke Severity ◽

Outcome Predictor ◽

Nihss Score ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

Favorable Group

Intravenous tissue plasminogen activator thrombolysis for stroke is still under use. A substantial proportion of excluded patients for mild or improving symptoms are dependent at discharge. We prospectively recruited 49 patients who did not receive thrombolysis because of mild or improving symptoms. 32 had favorable outcome (mRS ≤ 2) and 17 had unfavorable outcome (mRS > 2) at discharge. Comparisons were made between the two groups. Age was older (72.5 ± 10.0 versus 64.7 ± 13.2 years, P = 0.037), and initial National Institutes of Health Stroke Scale (NIHSS) score (5.7 ± 4.0 versus 2.2 ± 2.1, P < 0.001) was higher in the unfavorable group. Diastolic blood pressure was higher in the favorable group (98 ± 15 versus 86 ± 18 mmHg; P = 0.018). Atrial fibrillation (3.1 versus 23.5%; P = 0.043) and ipsilateral artery stenosis (21.9 versus 58.8%; P = 0.012) were more frequently found in the unfavorable group. Percentage of patients excluded from thrombolysis due to improving symptoms was higher in the unfavorable group (40.6 versus 82.4%; P = 0.005). Initial NIHSS score, but not other factors, was identified by logistic regression analysis as a major independent predictor for unfavorable outcome (OR 1.44; 95%CI, 1.03–2.02).

Download Full-text

Outcome of multimodal MRI-guided intravenous thrombolysis in patients with stroke with unknown time of onset

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000151 ◽

2019 ◽

Vol 4 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Jie Zhao ◽

Hongmei Zhao ◽

Runtao Li ◽

Jiangtao Li ◽

Chang Liu ◽

...

Keyword(s):

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

National Institutes Of Health ◽

Control Group ◽

Nihss Score ◽

Intravenous Tissue Plasminogen Activator ◽

Multimodal Mri ◽

The Difference ◽

Data Elements ◽

Treatment Window

ObjectiveIntravenous tissue plasminogen activator (tPA) is the standard therapy for patients with acute ischaemic stroke (AIS) within 4.5 hours of onset. Recent trials have expanded the endovascular treatment window to 24 hours. We investigated the efficacy and safety of using multimodal MRI to guide intravenous tPA treatment for patients with AIS of unknown time of onset (UTO).MethodsData on patients with AIS with UTO and within 4.5 hours of onset were reviewed. Data elements collected and analysed included: demographics, National Institutes of Health Stroke Scale (NIHSS) score at baseline and 2 hours, 24 hours, 7 days after thrombolysis and before discharge, the modified Rankin Scale (mRS) score at 3 months after discharge, imaging findings and any adverse event.ResultsForty-two patients with UTO and 62 in control group treated within 4.5 hours of onset were treated with intravenous tPA. The NIHSS scores after thrombolysis and/or before discharge in UTO group were significantly improved compared with the baseline (p<0.05). Between the two groups, no significant differences in NIHSS score were observed (p>0.05). Utilising the non-inferiority test, to compare mRS scores (0–2) at 3 months between the two groups, the difference was 5.2% (92% CI, OR 0.196). Patients in the UTO group had mRS scores of 0-2, which were non-inferior to the control group. Their incidence of adverse events was similar.ConclusionsUtilising multimodal MRI to guide intravenous only thrombolysis for patients with AIS with UTO was safe and effective. In those patients with AIS between 6 and 24 hours of time of onset but without large arterial occlusion, intravenous thrombolysis could be considered an option.

Download Full-text

Abstract 2808: The Prognosis of Intravenous Thrombolysis with Alteplase Relate to Site of Cerebral Artery Occlusion

Stroke ◽

10.1161/str.43.suppl_1.a2808 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Takao Kanzawa ◽

Ban Mihara ◽

Tomo horikoshi

Keyword(s):

Independent Predictor ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

National Institutes Of Health ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

Cerebral Artery Occlusion ◽

Mean Time ◽

Time Form ◽

Iv Tpa

Purpose: The objective of this study was to determine whether the arterial obstruction site is predictive of clinical outcomes in patients receiving intravenous tissue plasminogen activator (IV tPA). Methods: In a retrospective analysis of our stroke database between Nov. 2005 and May. 2011, we identified 91 consecutive patients who were treated with IV tPA within 3 hours after symptom onset of a stroke in the distribution of a documented ICA, proximal M1, distal M1, or M2/M3 occlusion by Magnetic resonance angiography. We analyzed the rate of favorable outcomes at 3 months (modified Rankin Scale 0 or 1) at various occlusion sites, and determined predictors of favorable outcomes. Results: 91 consecutive patients were treated (mean age, 71 +/- 11 yr; 40.9% were women). Median baseline National Institutes of Health Stroke Scale score (NIHSS) was 10 (range, 4 to 32) and mean time form onset to IV tPA was 128+/- 33 minutes. Favorable outcomes were achieved in 55.6% and significantly correlated with age, basal NIHSS and MRI ASPECT score. Based on the occlusion site, M2/M3 occlusion had an OR of 6.4 for favorable outcomes (83.7%, 95% CI: 2.2 to 19.2, P 0.0006), whereas the odds for proximal M1 occlusion was 0.163 (25.9%, 95% CI: 0.059 to 0.447, P 0.0004), ICA occlusion was 0.378 (23.0%, 95% CI: 0.138 to 1.036, P 0.01). After adjusting for age, sex, baseline NIHSS, and MRI ASPECT score, M2/M3 occlusion occlusion were an independent predictor to achieve favorable outcomes (OR: 9.203, 95% CI: 1.896 to 45.443, P 0.006). Conclusions: Clinical outcome in IV tPA depends on the site of occlusion. This is important to make reasonable decisions for identifying which patients benefit in IV tPA and combined IV tPA/ interventional approach.

Download Full-text

Abstract W P35: Assessment of Collaterals on Day-2 CT Angiography Can Predict Functional Outcome in Thrombolyzed Anterior Circulation Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp35 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

leonard L yeo ◽

Prakash Paliwal ◽

Hock Luen Teoh ◽

Raymond C Seet ◽

Bernard P Chan ◽

...

Keyword(s):

Functional Outcome ◽

Ct Angiography ◽

Treatment Time ◽

Multivariable Analysis ◽

Favourable Outcome ◽

Anterior Circulation ◽

Good Functional Outcome ◽

Intravenous Tissue Plasminogen Activator ◽

Younger Age ◽

Iv Tpa

Background: Several methods exist that assess the intracranial collaterals on CT-angiography (CTA) of the brain. We compared existing methods for quantification of collaterals on day-2 CTA in thrombolyzed AIS patients to assess their predictive value for functional outcome. Methods: Consecutive AIS patients treated with intravenous tissue plasminogen activator (IV-tPA) during 2007-2012 were included. Data were collected for demographics, vascular risk factors, NIHSS scores and stroke subtypes. Intracranial collaterals were evaluated by 2 independent neuroradiologists using 4 existing methods- Miteff’s system (grades middle cerebral artery (MCA) collateral branches with respect to sylvian fissure); Maas system (compares collaterals in affected hemisphere against the contralateral side); Modified Tan’s scale (collaterals in 50% or more of MCA territory classified as good); and 20-point collateral grading scale by Alberta Stroke Program Early CT score (ASPECTS) methodology. Good functional outcome at 3-months was determined by modified Rankin scale (mRS) scores of 0-1. Results: Day-2 CTA was performed in 150 patients with anterior circulation AIS treated with IV-tPA. Median age 66yrs (range 33-92), 47% males, median NIHSS 19 points (range 4-34) and median onset-to-treatment time 165 minutes (range 74-274). Overall, 67 (44.6%) patients achieved good functional outcome at 3-months. On univariable analysis- younger age, lower pre-tPA NIHSS scores, atrial fibrillation, good collaterals according to ASPECTS scoring and good collaterals by Maas methodology were significantly associated with good functional outcome. On multivariable analysis, lower NIHSS (OR 1.155 per NIHSS point; 95% CI 1.066-1.251, p=0.001), younger age (OR 1.052 per year; 95% CI 1.012-1.094, p=0.010), good collaterals by Maas methodology (OR 2.805 95% CI 1.122 -7.011, p =0.002) and good collaterals (score of 9 or more) by ASPECTS methodology (OR 3.769 ; 95%CI: 1.327- 10.708, p= 0.013 ) were found as independent predictors of good outcome. Conclusion: Of the existing intracranial collaterals scoring systems, only the ASPECTS and Maas methods are reliable predictor of favourable outcome in thrombolyzed anterior circulation AIS patients.

Download Full-text