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.
Key Words
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References
- Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 870-947
- Tissue plasminogen activator for acute ischemic stroke.N Engl J Med. 1995; 333: 1581-1587
- Hemorrhagic transformation in stroke patients.American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists. 2003; 82: 48-52
- Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS).JAMA. 1995; 274: 1017-1025
- ATLANTIS trial: results for patients treated within 3 hours of stroke onset. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke.Stroke. 2002; 33: 493-495
Article info
Publication history
Published online: December 08, 2015
Accepted:
November 4,
2015
Received in revised form:
October 30,
2015
Received:
September 25,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.006
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
