Deans' stroke musings: Multimodal CT or MRI for IV-Thrombolysis in ischemic stroke with unknown time of onset

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 22, 2020

Multimodal CT or MRI for IV-Thrombolysis in ischemic stroke with unknown time of onset

This is absolutely useless for survivors. When you present to the hospital with unknown time of onset you want your doctors to have EXACT PROTOCOLS LEADING TO 100% RECOVERY. This does nothing of the sort.

Multimodal CT or MRI for IV-Thrombolysis in ischemic stroke with unknown time of onset

, , , Michael Knott, Stefan Schwab, Arnd Doerfler, View ORCID ProfileBernd Kallmünzer, Tobias Engelhorn

First published October 21, 2020, DOI: https://doi.org/10.1212/WNL.0000000000011059

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Abstract

Objective

To investigate differences in procedure times, safety and efficacy outcomes comparing 2 different protocols to enable thrombolysis in the extended or unknown time window after stroke onset using either multimodal CT or MRI.

Methods

Patients with ischemic stroke in the extended or unknown time window, who received IV-thrombolysis between January 2011 and May 2019 were identified from an institutional registry. Imaging based selection was done by multimodal CT or MRI according to institutional treatment algorithms.

Results

IV-thrombolysis was performed in 100 patients (54.3%) based on multimodal CT-imaging and in 84 patients (45.7%) based on MRI. Baseline clinical data including stroke severity and time from last seen normal to hospital admission were similar in CT- and MRI-patients. Door-to-needle times were shorter in patients with CT-based selection (median [IQR] 45 minutes [37–62] vs 75 minutes [59–90]; mean difference [95% CI] −28 minutes [−35 to −21]). No differences were detected regarding the incidence of symptomatic intracranial hemorrhage (2 [2.0%] vs 4 [4.8%]; aOR [95% CI]: 0.47 [0.08–2.83]) and favorable outcome at day 90: 25 (33.8%) vs 33 (42.9%); aOR 0.95 (0.45–2.02).

Conclusion

IV-thrombolysis in ischemic stroke in the unknown or extended time window appeared safe in CT and MRI selected patients while the use of CT-imaging led to faster door-to-needle times.

Classification of evidence

This study provides Class IV evidence that for patients with ischemic stroke in the extended or unknown time window, imaging-based selection for IV-thrombolysis by multimodal CT compared to MRI led to shorter door-to-needle times.