Abstract Details

Title Association of Negative MRI Findings and Time-to-treatment in Stroke Patients Receiving tPA in a Community Hospital Setting

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-005

Objective To evaluate the relationship between onset-to-needle time and the occurrence of negative diffusion-weighted imaging (DWI) findings following intravenous tissue plasminogen activator (IV tPA) treatment

Background Timely administration of intravenous tissue plasminogen activator (IV tPA) remains critical for optimal outcomes in acute ischemic stroke. A subset of treated patients, however, exhibit no diffusion-weighted imaging (DWI) abnormalities on follow-up MRI. The relationship between time-to-treatment and negative MRI findings is not well characterized in community hospital settings, where imaging resources and workflows may differ from tertiary centers.

Design/Methods This retrospective study included adult patients who received IV tPA for suspected acute ischemic stroke between January and December 2024 at a community hospital. Clinical and imaging data were extracted from the institutional stroke registry, including demographics, onset-to-needle time (ONT), MRI findings within 72 hours, discharge diagnosis, and early neurological improvement (ENI). Patients were categorized as MRI-positive or MRI-negative based on DWI results. Group comparisons were performed using standard statistical methods.

Results Among 46 tPA-treated patients (mean age 69.1 ± 11.4 years; 48% male), 12 (26%) had no visible infarction on follow-up MRI. Median ONT was significantly shorter in the MRI-negative cohort (42 minutes [IQR 36–49]) compared with the MRI-positive cohort (58 minutes [IQR 42–78]; p < 0.01). MRI-negative patients were more often discharged with a diagnosis of transient ischemic attack or stroke mimic. No symptomatic intracerebral hemorrhages occurred in this group. ENI at 24 hours was observed in 61.5% of MRI-negative versus 44.3% of MRI-positive patients (p = 0.08).

Conclusions Shorter treatment times were associated with an increased likelihood of negative MRI findings following IV tPA administration. These results suggest that ultra-early reperfusion may prevent irreversible infarction or reflect treatment of TIAs or stroke mimics. Findings underscore the importance of rapid thrombolysis decision-making and support maintaining aggressive treatment timelines in community hospital settings.

Authors/Disclosures
Ali Hamzehloo, MD (HCA Florida Westside Hospital) PRESENTER	Dr. Hamzehloo has nothing to disclose.
Sonia Kalirao, MD (HCA Florida Westside Hospital)	Dr. Kalirao has nothing to disclose.

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