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Original article
Outcome of multimodal MRI-guided intravenous thrombolysis in patients with stroke with unknown time of onset
  1. Jie Zhao1,2,
  2. Hongmei Zhao1,2,
  3. Runtao Li2,3,
  4. Jiangtao Li1,2,
  5. Chang Liu2,4,
  6. Juan Lv1,2,
  7. Yanan Li1,2,
  8. Wei Liu1,2,
  9. Dongpu Ma1,2,
  10. Huaihai Hao2,3,
  11. Xinguang Xiao2,3,
  12. Junzhong Liu2,3,
  13. Yongfeng Yin1,2,
  14. Rongli Liu1,2,
  15. Qiaoyan Yu1,2,
  16. Yingjie Wei1,2,
  17. Pengyan Li1,2,
  18. Yue Wang1,2,
  19. Runqing Wang1,2
  1. 1 Department of Neurology, Zhengzhou Central Hospital, Zhengzhou, China
  2. 2 Stroke Center, Zhengzhou Central Hospital, Zhengzhou, China
  3. 3 Department of Imaging, Zhengzhou Central Hospital, Zhengzhou, China
  4. 4 Emergency Department, Zhengzhou Central Hospital, Zhengzhou, China
  1. Correspondence to Dr Runqing Wang; drwrqing{at}163.com

Abstract

Objective Intravenous tissue plasminogen activator (tPA) is the standard therapy for patients with acute ischaemic stroke (AIS) within 4.5 hours of onset. Recent trials have expanded the endovascular treatment window to 24 hours. We investigated the efficacy and safety of using multimodal MRI to guide intravenous tPA treatment for patients with AIS of unknown time of onset (UTO).

Methods Data on patients with AIS with UTO and within 4.5 hours of onset were reviewed. Data elements collected and analysed included: demographics, National Institutes of Health Stroke Scale (NIHSS) score at baseline and 2 hours, 24 hours, 7 days after thrombolysis and before discharge, the modified Rankin Scale (mRS) score at 3 months after discharge, imaging findings and any adverse event.

Results Forty-two patients with UTO and 62 in control group treated within 4.5 hours of onset were treated with intravenous tPA. The NIHSS scores after thrombolysis and/or before discharge in UTO group were significantly improved compared with the baseline (p<0.05). Between the two groups, no significant differences in NIHSS score were observed (p>0.05). Utilising the non-inferiority test, to compare mRS scores (0–2) at 3 months between the two groups, the difference was 5.2% (92% CI, OR 0.196). Patients in the UTO group had mRS scores of 0-2, which were non-inferior to the control group. Their incidence of adverse events was similar.

Conclusions Utilising multimodal MRI to guide intravenous only thrombolysis for patients with AIS with UTO was safe and effective. In those patients with AIS between 6 and 24 hours of time of onset but without large arterial occlusion, intravenous thrombolysis could be considered an option.

  • stroke with unknown time of onset
  • late reperfusion
  • IV thrombolysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2018-000151

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    Footnotes

    • JZ and HZ contributed equally.

    • Contributors JZ, HZ and RW had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: RW, JZ and HZ. Acquisition of clinical data: JLi, CL, JLv, YL, WL, DM, JLiu, YY, RL, QY, YW, PL and YW. Analysis and interpretation of data: JZ and HZ. Imaging diagnostic data analysis and interpretation: RL, XX and HH. Drafting of the manuscript: JZ and HZ. Critical revision of the manuscript for important intellectual content: JZ and RW. Statistical analysis: JZ and HZ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This is a retrospect review approved by the Zhengzhou Central Hospital Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.