Document Detail


[Perfusion computed tomography makes it possible to overcome important SITS-MOST exclusion criteria for the endovenous thrombolysis of cerebral infarction].
MedLine Citation:
PMID:  22362475     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
AIM. To study the frequency, safety and efficacy of perfusion computed tomography (PCT), through identification of brain tissue-at-risk, to guide intravenous thrombolysis in stroke patients with regulatory exclusion criteria (SITS-MOST and ECASS-3). PATIENTS AND METHODS. We studied consecutive acute non-lacunar ischemic stroke patients. After conventional CT was considered eligible, PCT was performed in the following circumstances: 4.5 to 6 h window, wake-up stroke or unknown time of onset; extent early infarct signs on CT; minor or severe stroke; seizures or loss of consciousness. Intravenous 0.9 mg/kg alteplase was indicated if: cerebral blood volume lesion covered < 1/3 of middle cerebral artery territory; mismatch > 20% between mean transit time and cerebral blood volume maps existed; and informed consent. SITS-MOST safety-efficacy parameters were used as endpoint variables. RESULTS. Between May 2009-April 2010, 66 hyperacute ischemic stroke patients a priori not eligible for intravenous thrombolysis underwent PCT. Indications were: > 4.5 h in 18 patients, wake up stroke or unknown onset in 25, extent infarct signs in 6, seizures at onset in 11, and minor stroke (NIHSS < 4) in 6. Twenty-nine (44%) of them finally received intravenous thrombolysis. Symptomatic hemorrhagic transformation occurred in 2 (6.9%) patient and 18 (62.1%) achieved a modified Rankin scale score equal or less than 2 on day 90. CONCLUSION. A high proportion of acute stroke patients with SITS-MOST and ECASS-3 exclusion criteria can be safely and efficaciously treated with intravenous thrombolysis using a PCT selection protocol. However randomized control trials will be needed to confirm our results.
Authors:
E Cortijo; A I Calleja; P Garcia-Bermejo; S Perez-Fernandez; J M Del Monte; N Tellez; D M Campos-Blanco; M A Garcia-Porrero; M R Fernandez-Herranz; J F Arenillas-Lara
Publication Detail:
Type:  English Abstract; Journal Article    
Journal Detail:
Title:  Revista de neurologia     Volume:  54     ISSN:  1576-6578     ISO Abbreviation:  Rev Neurol     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7706841     Medline TA:  Rev Neurol     Country:  Spain    
Other Details:
Languages:  spa     Pagination:  271-6     Citation Subset:  IM    
Affiliation:
Hospital Clinico Universitario de Valladolid, 47005 Valladolid, Espana.
Vernacular Title:
La tomografia computarizada de perfusion permite superar importantes criterios de exclusion SITS-MOST para la trombolisis endovenosa del infarto cerebral.
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