MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort study

详细信息    查看全文

• 作者：Martin Kö ; hrmann ; Eric Jü ; ttler ; Jochen B Fiebach ; Hagen B Huttner ; Stefan Siebert ; Christian Schwark ; Peter A Ringleb ; Peter D Schellinger and Werner Hacke
• 刊名：Lancet Neurology
• 出版年：2006
• 出版时间：August 2006
• 年：2006
• 卷：5
• 期：8
• 页码：661-667
• 全文大小：96 K

文摘

ass=""h3"">Summary

ass=""h4"">Background

Thrombolytic treatment with recombinant tissue plasminogen activator (rtPA) is approved for use within 3 h after stroke onset. Thus only a small percentage of patients can benefit. Meta-analyses and more recent studies suggest a benefit for a subset of patients beyond 3 h. We assessed the safety and efficacy of an MRI-based selection protocol for stroke treatment within and beyond 3 h compared with standard CT-based treatment.

ass=""h4"">Methods

We assessed clinical outcome and incidence of symptomatic intracerebral haemorrhage (ICH) in 400 consecutive patients treated with intravenous rtPA. Patients eligible for thrombolysis within 3 h were selected by CT or MRI and beyond 3 h only by MRI. 18 patients were excluded from analysis because of violation of that algorithm. The remaining 382 patients were divided into three groups: CT-based treatment within 3 h (n=209); MRI-based treatment within 3 h (n=103); and MRI-based treatment beyond 3 h (n=70).

ass=""h4"">Findings

Patients in group 3 (MRI >3 h) had a similar 90 day outcome to those in the other two groups (48 % were independent in the CT ≤ 3 h group, 51 % in the MRI ≤ 3 h group, and 56 % in group 3), but without an increased risk for symptomatic ICH (9 % , 1 % , 6 % ) or mortality (21 % , 13 % , 11 % ). MRI-selected patients overall had a significantly lower risk than CT-selected patients for symptomatic ICH (3 % vs 9 % ; p=0·013) and mortality (12 % vs 21 % ; p=0·021). Time to treatment did not affect outcomes in univariate and multivariate analyses.

ass=""h4"">Interpretation

Our data suggest that beyond 3 h and maybe even within 3 h, patient selection is more important than time to treatment for a good outcome. Furthermore, MRI-based thrombolysis, irrespective of the time window, shows an improved safety profile while being at least as effective as standard CT-based treatment within 3 h.