Too good to treat? ischemic stroke patients with small computed tomography perfusion lesions may not benefit from thrombolysis

In this study, we tested the hypothesis that a small acute perfusion lesion predicts good clinical outcome regardless of thrombolysis administration. MethodsWe used a prospectively collected cohort of acute ischemic stroke patients being assessed for treatment with IV‐alteplase, who had CTP before a treatment decision. Volumetric CTP was retrospectively analyded to identify patients with a small perfusion lesion (<15ml in volume). The primary analysis was excellent 3‐month outcome in patients with a small perfusion lesion who were treated with alteplase compared to those who were not treated. ResultsOf 1526 patients, 366 had a perfusion lesion <15ml and were clinically eligible for alteplase (212 being treated and 154 not treated). Median acute National Institutes of Health Stroke Scale score was 8 in each group. Of the 366 patients with a small perfusion lesion, 227 (62%) were modified Rankin Scale (mRS) 0 to 1 at day 90. Alteplase‐treated patients were less likely to achieve 90‐day mRS 0 to 1 (57%) than untreated patients (69%; relative risk [RR] = 0.83; 95% confidence interval [CI], 0.71–0.97; p = 0.022) and did not have different rates of mRS 0 to 2 (72% treated patients vs 77% untreated; RR, 0.93; 95% CI, 0.82–1.95; p = 0.23). InterpretationThis large observational cohort suggests that a portion of ischemic stroke patients clinically eligible for alteplase therapy with a small perfusion lesion have a good natural history and may not benefit ...
Source: Annals of Neurology - Category: Neurology Authors: Tags: Research Article Source Type: research