Abstract Details

Title Is a Routine Head CT after IV-tPA Therapy Medically Necessary?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 170

Objective

Background BACKGROUND: Clinical trials of thrombolysis for acute stroke require post-therapy neuroimaging to determine the safety endpoint of intracranial hemorrhage (ICH). After IV-tPA approval, the NINDS protocol was adopted into clinical practice despite a low risk of ICH. New models are available to predict the risk of ICH after thrombolysis.

Design/Methods DESIGN/METHODS: All patients receiving IV-tPA for acute ischemic stroke from 1/10-6/11 were retrospectively reviewed. Patients with rescue IA-tPA or mechanical thrombectomy were excluded. GRASPS and HAT scores were calculated.

Results RESULTS: Of 117 patients, 85 received IV-tPA alone. Symptomatic parenchymal hemorrhage occurred in 3.5% and neuroimaging disclosed an additional 7.0% with asymptomatic petechial hemorrhagic transformation. Patients with hemorrhagic conversion had higher mean GRASPS score, however, the difference was not statistically significant (71.66 vs 66.54, p=0.17). Mean GRASPS score was significantly higher for patients with symptomatic ICH (80 vs 66.54, p=0.02). Hemorrhagic conversion was not associated with cortical location (OR 2.02, CI 0.23-17.55, p=0.52), HAT score, or mean NIHSS (10.5 vs 10.25, p=0.9). All patients with hemorrhagic conversion received antiplatelet medications, 24 hours after thrombolytic therapy. Discovery of hemorrhagic transformation altered the medical management in only one case. The patient had atrial fibrillation and anticoagulation was deferred, and aspirin initiated.

Conclusions CONCLUSIONS: In clinical practice, the risk of symptomatic ICH after IV-tPA is low. GRASPS scores may be helpful in identifying patients at higher risk for ICH but it is not sufficiently sensitive to guide a selective use for post-therapy surveillance imaging. A protocol requiring repeat neuroimaging at 24 hr after IV-tPA is not supported by clinical practice data. Neuroimaging after IV-tPA should focus on vascular imaging needed for determining the mechanism and treatment plan and to evaluate the cause of clinical deterioration after therapy.

Authors/Disclosures
Siddharth Sehgal, MD (Lahey Medical Center) PRESENTER	Dr. Sehgal has nothing to disclose.
Michael Bazelot, PhD (University of Reading)	No disclosure on file
Prachi Mehndiratta, MD	Dr. Mehndiratta has nothing to disclose.
Murad M. Talahma, MD (Ochsner Medical Center)	No disclosure on file
Sylvia C. Kurz, MD, PhD (Yale University School of Medicine)	Dr. Kurz has received personal compensation in the range of $0-$499 for serving as a Consultant for Advanced Accelerator Applications.
Cathy A. Sila, MD, FAAN (Neurological Institute Cleveland Medical Center)	Dr. Sila has nothing to disclose.

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