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Background

There is an ongoing debate whether stroke patients presenting with minor or moderate symptoms benefit from thrombolysis. Up until now, stroke severity on admission is typically measured with the NIHSS, and subsequently used for treatment decision.

Hypothesis

Acute MRI lesion volume assessment can aid in therapy decision for iv-tPA in minor stroke.

Methods

We analysed 164 patients with NIHSS 0–7 from a prospective stroke MRI registry, the 1000+ study clinicaltrials.org NCT00715533. Patients were examined in a 3 T MRI scanner and either received n = 62 or did not receive thrombolysis n = 102. DWI diffusion weighted imaging and PI perfusion imaging at admission were evaluated for diffusion - perfusion mismatch. Our primary outcome parameter was final lesion volume, defined by lesion volume on day 6 FLAIR images.

Results

The association between t-PA and FLAIR lesion volume on day 6 was significantly different for patients with smaller DWI volume compared to patients with larger DWI volume interaction between DWI and t-PA: p = 0.021. Baseline DWI lesion volume was dichotomized at the median 0.7 ml: final lesion volume at day 6 was larger in patients with large baseline DWI volumes without t-PA treatment median difference 3, IQR −0.4–9.3 ml. Conversely, in patients with larger baseline DWI volumes final lesion volumes were smaller after t-PA treatment median difference 0, IQR −4.1–5 ml. However, this did not translate into a significant difference in the mRS at day 90 p = 0.577.

Conclusion

Though this study is only hypothesis generating considering the number of cases, we believe that the size of DWI lesion volume may support therapy decision in patients with minor stroke.

Trial Registration

Clinicaltrials.org NCT00715533



Autor: Kersten Villringer , Ulrike Grittner, Lars-Arne Schaafs, Christian H. Nolte, Heinrich Audebert, Jochen B. Fiebach

Fuente: http://plos.srce.hr/



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