Background
Patients presenting with mild stroke symptoms are excluded inconsistently from intravenous
(IV) thrombolysis. We aimed to compare acute magnetic resonance imaging findings in
patients with mild symptoms to those with more severe deficits to identify clinically
mild patients who might benefit from IV thrombolysis.
Methods
We retrospectively studied consecutive stroke patients presenting with perfusion deficit
who underwent time-of-flight magnetic resonance angiography within 24 hours of time
last seen normal. Two raters measured the lesion volumes on diffusion-weighted imaging
(DWI) and perfusion-weighted imaging (PWI) with mismatch (MM) calculated as PWI minus
DWI. Occlusion site was categorized as “proximal,” “distal,” or “magnetic resonance
angiography-negative” by consensus review. Stroke with mild symptoms was defined as
admit National Institutes of Health Stroke Scale score of 4 or less. Values were reported
as n (%).
Results
Ninety-one patients were included; 56 (61.5%) with nonmild and 35 (38.5%) with mild
symptoms. After stratifying for occlusion site, there were no differences in PWI and
MM lesion volumes for the nonmild versus mild patients (P = .34-.98 and P = .54-1, respectively). Furthermore, there was a trend for thrombolyzed mild stroke
patients (88%, n = 7 of 8) to more likely have a favorable clinical outcome (discharge
modified Rankin score ≤ 2) versus untreated patients (70%, n = 16 of 23).
Conclusions
When present, conspicuous vessel occlusions in clinically mild stroke patients are
concomitant with similar perfusion deficit and MM volumes in more clinically severe
stroke patients. Coupled with a trend toward better outcomes in mild stroke patients
who were treated with IV tissue plasminogen activator (t-PA), this could indicate
that advanced imaging may be used in standardizing the way these patients are selected
for IV t-PA therapy.
Key Words
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Article info
Publication history
Published online: May 18, 2015
Accepted:
April 12,
2015
Received:
February 15,
2015
Footnotes
T.B. contributed to article drafting/revision, study concept/design, and acquisition/statistical analysis/interpretation of data. M.L. contributed to article drafting/revision, study concept/design, and acquisition/statistical analysis/interpretation of data. J.S. contributed to article revision and acquisition/interpretation of data. D.G. contributed to article revision and acquisition/interpretation of data. L.L. contributed to article drafting/revision, study concept/design, statistical analysis/interpretation of data, and study supervision.
This research was supported by the Division of Intramural Research of the National Institute of Neurological Disorders and Stroke, NIH (NIH project number 1ZIANS003044-08). The authors have no disclosures.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.012
Copyright
Published by Elsevier Inc.
