Thrombolysis in Stroke With Unknown Onset Based on Non‐Contrast Computerized Tomography (TRUST CT)

Autor: Marek Sykora, Lars Kellert, Patrik Michel, Ashraf Eskandari, Katharina Feil, Jan Rémi, Julia Ferrari, Stefan Krebs, Wilfried Lang, Wolfgang Serles, Pavel Siarnik, Peter Turcani, Michal Kovacik, Benjamin Bender, Annerose Mengel, Khouloud Poli, Sven Poli
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 9, Iss 4 (2020)
Druh dokumentu: article
ISSN: 2047-9980
DOI: 10.1161/JAHA.119.014265
Popis: Background Intravenous thrombolysis (IVT) in wake‐up stroke (WUS) or stroke with unknown onset (SUO) has been recently proven to be safe and effective using advanced neuroimaging (magnetic resonance imaging or computerized tomography‐perfusion) for patient selection. However, in most of the thrombolyzing centers advanced neuroimaging is not instantly available. We hypothesize that pragmatic non‐contrast computed tomography‐based IVT in WUS/SUO may be feasible and safe. Methods and Results TRUST‐CT (Thrombolysis in Stroke With Unknown Onset Based on Non‐Contrast Computerized Tomography) is an international multicenter registry‐based study. WUS/SUO patients undergoing non‐contrast computed tomography‐based IVT with National Institute of Health Stroke Scale ≥4 and initial Alberta Stroke Program Early Computerized Tomography score ≥7 were included and compared with propensity score matched non‐thrombolyzed WUS/SUO controls. Primary end point was the incidence of symptomatic intracranial hemorrhage; secondary end points included 24‐hour National Institute of Health Stroke Scale improvement of ≥4 and modified Rankin Scale at 90 days. One hundred and seventeen WUS/SUO patients treated with non‐contrast computed tomography‐based IVT were included. As compared with 112 controls, the median admission National Institute of Health Stroke Scale was 10 and the median Alberta Stroke Program Early Computerized Tomography score was 10 in both groups. Four (3.4%) IVT patients and one control patient (0.9%) suffered symptomatic intracranial hemorrhage (adjusted odds ratio 7.9, 95% CI 0.65–96, P=0.1). A decrease of ≥4 National Institute of Health Stroke Scale points was observed in 67 (57.3%) of IVT patients as compared with 25 (22.3%) in controls (adjusted odds ratio 5.8, CI 3.0–11.2, P
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