Baseline computed tomography changes and clinical outcome after thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke

Objective. Intravenous recombinant tissue plasminogen activator (rt-PA) is the only therapy of proven value for patients with acute ischemic stroke (A IS). Controversy exists with regard to the prognostic significance of early computed tomography (CT) changes in patients receiving rt-PA for AIS. The authors retrospectively reviewed all cases of AIS who received intravenous rt-PA for AIS in University of South Alabama hospitals between January 1996 and May 1999. A neuroradiologist, blinded to clinical outcomes, reviewed a ll baseline CT scans for the presence of the following signs: hyperdense mi ddle cerebral artery (HMCA), loss of gray-white differentiation (LGWD), ins ular ribbon sign (IRS), parenchymal hypodensity (PH), and sulcal effacement (SE). Modified Rankin Scale (mRS) score was recorded 90 days after thrombo lysis, and clinical outcome was dichotomized as favorable (0-1) or unfavora ble (2-6). The authors performed both univariate and multivariate analyses to investigate the relationship between early CT signs, baseline clinical v ariables, and functional outcome as measured by the 90-day mRS scores. Any one early CT finding was detected in 23 (64%) patients. The frequency of sp ecific findings were as follows: SE in 13 patients (36%), LGWD in 12 patien ts(33%), PH in 9 patients (25%), HMCA in 4 patients (11%), and IRS in 3 pat ients (8%) patients. There was no statistically significant association bet ween the occurrence of these imaging findings and subsequent functional out come after thrombolysis. The data suggest that the presence of subtle acute CT changes in AIS patients is not predictive of clinical outcome following administration of rt-PA as per National Institute of Neurological Disorder s and Stroke protocol.