MRI screening before standard tissue plasminogen activator therapy is feasible and safe

Dong Wha Kang, Julio A. Chalela, William Dunn, Steven Warach

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background and Purpose - MRI screening for thrombolytic therapy may improve patient selection. Alternatively, it may excessively delay treatment and thereby lead to worse outcomes. We hypothesized that times to treatment and outcomes in a stroke center with immediate MRI access and interpretation would not differ from those of the typical clinical practice. Methods - We compared the results of 120 consecutive patients treated with intravenous tissue plasminogen activator (tPA) within 3 hours of onset at our center with those of the 2 largest multicenter registries of tPA use. In addition to standard criteria, MRI specific eligibility criteria were applied in 97 patients. MRI was not performed in 23 patients because of contraindications to MRI or late patient arrival (>2.5 hours). Outcomes were the modified Rankin Scale (mRS) obtained at 3 months. Results - Times to treatment (median door-to-needle time 81.5 minutes; median onset-to-needle time 135 minutes) and outcomes (mRS 0 to 1, 40.8%; mRS 0 to 2, 47,5%) were not inferior to those of the typical clinical practice. Door-to-needle time was shorter in computed tomography (CT) screening (67.5±22.5 minutes; n=23) than in MRI screening (86.8±21.5 minutes; n=97; P<0.001). However, outcomes were not different between MRI screening (mRS 0 to 1, 42.3%; mRS 0 to 2, 49.5%) and CT screening (mRS 0 to 1, 34.8%; mRS 0 to 2, 39.1%). Neither times to treatment nor MRI screening was predictive of outcomes. Conclusion - These data demonstrate that MRI screening before tPA therapy is feasible and not associated with unacceptable times to treatment or outcomes.

Original languageEnglish (US)
Pages (from-to)1939-1943
Number of pages5
JournalStroke
Volume36
Issue number9
DOIs
StatePublished - Sep 2005

Fingerprint

Tissue Plasminogen Activator
Needles
Therapeutics
Tomography
Thrombolytic Therapy
Patient Selection
Registries
Stroke

Keywords

  • Magnetic resonance imaging
  • Stroke, acute
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

MRI screening before standard tissue plasminogen activator therapy is feasible and safe. / Kang, Dong Wha; Chalela, Julio A.; Dunn, William; Warach, Steven.

In: Stroke, Vol. 36, No. 9, 09.2005, p. 1939-1943.

Research output: Contribution to journalArticle

Kang, Dong Wha ; Chalela, Julio A. ; Dunn, William ; Warach, Steven. / MRI screening before standard tissue plasminogen activator therapy is feasible and safe. In: Stroke. 2005 ; Vol. 36, No. 9. pp. 1939-1943.
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abstract = "Background and Purpose - MRI screening for thrombolytic therapy may improve patient selection. Alternatively, it may excessively delay treatment and thereby lead to worse outcomes. We hypothesized that times to treatment and outcomes in a stroke center with immediate MRI access and interpretation would not differ from those of the typical clinical practice. Methods - We compared the results of 120 consecutive patients treated with intravenous tissue plasminogen activator (tPA) within 3 hours of onset at our center with those of the 2 largest multicenter registries of tPA use. In addition to standard criteria, MRI specific eligibility criteria were applied in 97 patients. MRI was not performed in 23 patients because of contraindications to MRI or late patient arrival (>2.5 hours). Outcomes were the modified Rankin Scale (mRS) obtained at 3 months. Results - Times to treatment (median door-to-needle time 81.5 minutes; median onset-to-needle time 135 minutes) and outcomes (mRS 0 to 1, 40.8{\%}; mRS 0 to 2, 47,5{\%}) were not inferior to those of the typical clinical practice. Door-to-needle time was shorter in computed tomography (CT) screening (67.5±22.5 minutes; n=23) than in MRI screening (86.8±21.5 minutes; n=97; P<0.001). However, outcomes were not different between MRI screening (mRS 0 to 1, 42.3{\%}; mRS 0 to 2, 49.5{\%}) and CT screening (mRS 0 to 1, 34.8{\%}; mRS 0 to 2, 39.1{\%}). Neither times to treatment nor MRI screening was predictive of outcomes. Conclusion - These data demonstrate that MRI screening before tPA therapy is feasible and not associated with unacceptable times to treatment or outcomes.",
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