IV t-PA influences infarct volume in minor stroke: a pilot study

Abstract

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.

Conflict of interest statement

Competing Interests: KV reports that receiving consulting fees by Bayer Schering and JBF reports receiving consulting, lecture and advisory board fees by BMS, Siemens, Perceptive, Synarc, BioImaging Technologies, Novartis, Wyeth, Pfizer, Boehringer Ingelheim, Lundbeck and Sygnis do not alter their adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1. CONSORT 2010 Flow Diagram.

Figure 2. Association between DWI volume day 1 and FLAIR volume day 6.

Figure 3. Lesion volume development in minor/moderate stroke after iv t-PA.

Figure 4. Lesion volume development in minor/moderate stroke without therapy.