Multimodal CT imaging and recanalizing therapy in acute ischemic stroke: retrospective analysis of a one-year single-center experience.

BACKGROUND

Recanalizing therapy in ischemic stroke is restricted to thrombolysis within 3 h. Multimodal imaging of vessel and parenchymal perfusion status may allow the extension of this time window.

AIM

To retrospectively analyze treatment results of any recanalizing therapy in clinical practice.

METHODS

Patients comprised three groups: 'standard' intravenous thrombolysis within 3 h; 'off-label' intravenous thrombolysis, and off-label interventional therapy. Recanalizing therapy was applied dependent on multimodal CT according to standardized pathways. Short-term clinical courses were analyzed.

RESULTS

Of 543 patients (ischemic stroke, TIA), 68 (12.5%) received some type of recanalizing therapy. Of these, 47 (mean age 73.4, 24 female, mean symptom onset and hospital admission 62 min) received standard and 10 off-label thrombolysis (70.8, 6 female, 332 min), and 11 interventional therapy, mostly mechanical thrombectomy (mean age 62.5, 7 female, 186 min). Mean Δ short-term National Institutes of Health Stroke Scale (2-5 days) in these three groups were 3.7 ± 4.7, 3.9 ± 4.4, and 4.1 ± 5.8, respectively. The short-term clinical benefit was similar in the three groups.

CONCLUSION

Off-label therapy is considered to have a higher risk of complications. However, if multimodal CT imaging of acute ischemic stroke is incorporated in everyday clinical decision-making, the rate of effective recanalizing procedures may be increased without an apparent negative effect on short-term outcome.