Abstract Details

Title The Utility of Basic Head CT (CTH) in Intravenous rt-PA (IV-rtPA) Treatment of Stroke with Unknown Time of Onset (UTO)

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 233

Objective

Background BACKGROUND: The 3 hour window for IV-rtPA excludes patients with UTO--wakeup (WU) or found down (FD). Because CTH in the NINDS rtPA trial were normal or had early ischemic change (EIC), we hypothesized that such CT findings would apply in WU and FD patients.

Design/Methods DESIGN/METHODS: Following IRB approval, we analyzed results for WU and FD stroke patients treated based on CTH. Consent was obtained after explanation that benefits/risks were uncertain. CT angiography (CTA) was done in all, but treatment was based on CTH. Outcomes measures at discharge were improvement in NIHSS, mRS 0-1, 2, 3, sICH, mortality, discharge disposition.

Results RESULTS: 57 patients treated: WU 38, FD 19, median age 70 years, 51% male. Time (mean) from WU/FD to treatment 2.7 hours (no difference between WU and FD), door to drug 66 minutes, admission NIHSS 10.5. CTH normal in 74%; CTA normal in 53%. Discharge NIHSS 7, NIHSS change (-)2.9, mRS 0-1=21%, mRS 2=27%, mRS 3= 9%, death=2% ICH=0. Associated with favorable outcome (mRS 0-2) (p ?0.05) were: WU onset, younger, normal CTA, noncardiogenic stroke, lower admission NIHSS. WU > FD (p ?0.05): male, Hispanic, lacunar stroke, lower admission NIHSS, lower discharge mRS, discharged home. FD > WU (p ?0.05): CTA occlusion, discharged hospice. Compared to 90 day NINDS trial: mRS 0-1: 21% v 39%; mRS 2-3: 57% v 60%. Death: 2% v 17%. ICH: 0 v 6.4%.

Conclusions CONCLUSIONS: Our results suggest utility of CTH in IV-rtPA treatment of stroke with UTO. Outcomes are better for WU than FD, consistent with lesser severity, fewer CTA occlusions, possible onset near awakening. Randomized comparison of CTH, CTP, MRI FLAIR/DWI will be important to determine optimum imaging for stroke with UTO.

Authors/Disclosures
Wei Liu, MD PRESENTER	Dr. Liu has nothing to disclose.
Craig McDonald, MD (UC Davis Dept. of PM&R)	Dr. McDonald has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sarepta Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PTC Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Solid Biosciences. Dr. McDonald has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Solid Biosciences. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edgewise Therapeutics. The institution of Dr. McDonald has received research support from Sarepta Therapeutics. The institution of Dr. McDonald has received research support from PTC Therapeutics. The institution of Dr. McDonald has received research support from Edgewise Therapeutics. The institution of Dr. McDonald has received research support from Capricor Therapeutics. The institution of Dr. McDonald has received research support from Italfarmaco. Dr. McDonald has received research support from NS Pharma. The institution of Dr. McDonald has received research support from NIH (NINDS). The institution of Dr. McDonald has received research support from Parent Project Muscular Dystrophy. The institution of Dr. McDonald has received research support from Muscular Dystrophy Association. Dr. McDonald has received personal compensation in the range of $500-$4,999 for serving as a Member National Advisory Board for Medical Rehabilitation Research with NIH.
	No disclosure on file
Joni M. Clark, MD (Eisenhower Medical Center)	No disclosure on file
	No disclosure on file
Kamala Saha, MD, FAAN	Dr. Saha has nothing to disclose.
Christina L. Saldivar, MD (St. Davids Neurology)	No disclosure on file
Marc Malkoff, MD, FAAN (University of Tennessee)	Dr. Malkoff has nothing to disclose.
Georgios Tsivgoulis, MD, FAAN (NEURODIAGNOSTICS AND NEUROTHERAPEUTICS PC)	Dr. Tsivgoulis has nothing to disclose.
Andrei V. Alexandrov, MD (Department of Neurology, UTHSC)	The institution of Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovoNordisc. Dr. Alexandrov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca. Dr. Alexandrov has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for American Society of Neuroimaging. Dr. Alexandrov has received publishing royalties from a publication relating to health care.
	No disclosure on file
James L. Frey, MD, FAAN	No disclosure on file

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