Computed Tomography Angiography in Acute Stroke Patients Receiving Recombinant Tissue Plasminogen Activator: Outcome and Safety Evaluations in an Asian Population

Chuan Min Lin, Hsiu Chuan Wu, Yi Ming Wu, Chi Hung Liu, Kuo Hsuan Chang, Ting Yu Chang, Kuo Lun Huang, Yeu Jhy Chang, Tsong Hai Lee, Pei Kwei Tsay, Chih Kuang Cheng, Chien Hung Chang

Research output: Contribution to journalJournal Article peer-review

3 Scopus citations

Abstract

Introduction: The multiphase computed tomography angiography (mCTA) is superior to the noncontrast computed tomography (NCCT) in selecting patients that would benefit from mechanical thrombectomy following an acute ischemic stroke (AIS). It remains unclear whether the longer examination time of mCTA worsens outcomes of intravenous recombinant tissue plasminogen activator (IV r-tPA) or increases the risk of hemorrhagic transformation (HT) compared to NCCT in Asian stroke patients. Methods: Between January 2011 and December 2017, 199 AIS patients receiving IV r-tPA with initial National Institute of Health Stroke Scale (NIHSS) scores between 6 and 25 were enrolled in a single medical center. Onset-to-needle time (ONT), door-to-needle time (DNT), and creatinine levels before and after thrombolysis were recorded. We evaluated NIHSS scores 2, 24 h after treatment, and at discharge, the modified Rankin Scale (mRS) at discharge, and mortality rate. The presence of HT was reviewed within 7 days after thrombolysis. Results: DNT, perithrombolysis creatinine levels, NIHSS, and mRS scores at the emergency room were similar between the NCCT and mCTA groups. ONT was shorter in the mCTA group. AIS patients got more significant neurologic improvement (NIHSS decrease ≥4) after thrombolysis and physically independent (mRS ≤2) at discharge in the mCTA group. Mortality rates, symptomatic, and total HT rates were similar between the NCCT and mCTA groups. Conclusion: Comparing to NCCT, mCTA-based IV r-tPA would not delay DNT nor worsen the outcome. Furthermore, mCTA provides more information for early identification of candidates for mechanical thrombectomy in Asian AIS patients.

Original languageEnglish
Pages (from-to)62-69
Number of pages8
JournalCerebrovascular Diseases
Volume49
Issue number1
DOIs
StatePublished - 01 03 2020

Bibliographical note

Publisher Copyright:
© 2020 S. Karger AG, Basel. All rights reserved.

Keywords

  • Acute ischemic stroke
  • Asian
  • Intravenous recombinant tissue plasminogen activator
  • Multiphase computed tomography angiography

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