on behalf of the TRISP collaborators
In recent RCTs intravenous thrombolysis (IVT) beyond 4.5 hours of stroke onset was safe and effective, if patient selection was based on distinct advanced imaging criteria. However, in real-life, the impact of imaging-based patient selection for IVT >4.5 hours on outcomes is ambiguous. We aimed at comparing outcomes of patients treated with IVT between >4.5-9 hours dependent on the type of baseline imaging.
Stroke patients treated with IVT >4.5-9 hours after stroke onset from the prospective ThRombolysis in Ischaemic Stroke Patients (TRISP) registry were included. We compared (i) patients with advanced imaging to those without and (ii) patients with CT-Perfusion (CTP) to those with MR-Perfusion or MR-DWI/FLAIR (MRI). Outcomes were sICH (ECASS-II-criteria), poor 3-month outcome (mRS 3-6) and mortality. We calculated adjusted OR with 95%-CI using logistic regression models.
Of 652 patients treated with IVT between >4.5-9 hours after stroke onset, 454 (69.6%) had advanced imaging (210 MRI; 244 CTP) and 198 (30.4%) did not. The occurrence of basilar occlusion was evenly distributed (2.5% vs 3.5%). With advanced imaging the probability of death was independently lower than without advanced imaging (9.7% vs. 20.2%, ORadjusted 0.47[0.26-0.86]), but not of sICH (ORadjusted 1.39[0.55-3.52]) and poor outcome ORadjusted 0.85[0.54-1.33]). No independent association was found between the two types of advanced imaging and any outcome.
Patient selection for IVT in the extended time window based on advanced imaging was not associated with better functional outcome, but mortality was independently lower. Moreover, the type of advanced imaging (CTP or MRI) does not seem to matter.
Not applicable