Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke
(2016) In Neurology 86(2). p.25-118- Abstract
OBJECTIVE: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3).
METHODS: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518).
RESULTS: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio... (More)
OBJECTIVE: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3).
METHODS: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518).
RESULTS: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio [OR] 0.66, p < 0.001). Outcome was worse in patients with more (vs less) extensive HAS (OR 0.61, p = 0.027) but not in proximal (vs distal) HAS (p = 0.420). Increasing age was associated with more HAS growth at follow-up (OR 1.01, p = 0.013). Treatment with alteplase increased HAS shrinkage/disappearance at follow-up (OR 0.77, p = 0.006). There was no significant difference in HAS shrinkage with alteplase in proximal (vs distal) or more (vs less) extensive HAS (p = 0.516 and p = 0.580, respectively). There was no interaction between presence vs absence of HAS and benefit of alteplase on 6-month OHS (p = 0.167).
CONCLUSIONS: IV alteplase promotes measurable reduction in HAS regardless of HAS location or extent. Alteplase increased independence at 6 months in patients with and without HAS.
CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients within 6 hours of ischemic stroke with a CT hyperdense artery sign, IV alteplase reduced intra-arterial hyperdense thrombus.
(Less)
- author
- author collaboration
- publishing date
- 2016-01-12
- type
- Contribution to journal
- publication status
- published
- keywords
- Aged, Aged, 80 and over, Arteries, Brain Ischemia, Female, Fibrinolytic Agents, Follow-Up Studies, Humans, Male, Stroke, Tissue Plasminogen Activator, Tomography, X-Ray Computed, Treatment Outcome, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
- in
- Neurology
- volume
- 86
- issue
- 2
- pages
- 8 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:26658907
- scopus:84954342168
- ISSN
- 1526-632X
- DOI
- 10.1212/WNL.0000000000002236
- language
- English
- LU publication?
- no
- id
- 636f7e75-ccb2-4e4b-be7c-c940ff251f89
- date added to LUP
- 2017-08-14 11:43:34
- date last changed
- 2024-04-14 15:35:43
@article{636f7e75-ccb2-4e4b-be7c-c940ff251f89,
abstract = {{<p>OBJECTIVE: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3).</p><p>METHODS: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518).</p><p>RESULTS: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio [OR] 0.66, p < 0.001). Outcome was worse in patients with more (vs less) extensive HAS (OR 0.61, p = 0.027) but not in proximal (vs distal) HAS (p = 0.420). Increasing age was associated with more HAS growth at follow-up (OR 1.01, p = 0.013). Treatment with alteplase increased HAS shrinkage/disappearance at follow-up (OR 0.77, p = 0.006). There was no significant difference in HAS shrinkage with alteplase in proximal (vs distal) or more (vs less) extensive HAS (p = 0.516 and p = 0.580, respectively). There was no interaction between presence vs absence of HAS and benefit of alteplase on 6-month OHS (p = 0.167).</p><p>CONCLUSIONS: IV alteplase promotes measurable reduction in HAS regardless of HAS location or extent. Alteplase increased independence at 6 months in patients with and without HAS.</p><p>CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients within 6 hours of ischemic stroke with a CT hyperdense artery sign, IV alteplase reduced intra-arterial hyperdense thrombus.</p>}},
author = {{Mair, Grant and von Kummer, Rüdiger and Morris, Zoe and von Heijne, Anders and Bradey, Nick and Cala, Lesley and Peeters, André and Farrall, Andrew J and Adami, Alessandro and Potter, Gillian and Cohen, Geoff and Sandercock, Peter A G and Lindley, Richard I. and Wardlaw, Joanna M. and Cronberg, Tobias}},
issn = {{1526-632X}},
keywords = {{Aged; Aged, 80 and over; Arteries; Brain Ischemia; Female; Fibrinolytic Agents; Follow-Up Studies; Humans; Male; Stroke; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Treatment Outcome; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't}},
language = {{eng}},
month = {{01}},
number = {{2}},
pages = {{25--118}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Neurology}},
title = {{Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke}},
url = {{http://dx.doi.org/10.1212/WNL.0000000000002236}},
doi = {{10.1212/WNL.0000000000002236}},
volume = {{86}},
year = {{2016}},
}