Intravenous Recombinant Tissue Plasminogen Activator Improves Arterial Recanalization Rates and Reduces Infarct Volumes in Patients With Hyperdense Artery Sign on Baseline Computed Tomography

Christopher Nichols, Jane Khoury, Thomas G Brott, Joseph Broderick

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: We sought to evaluate arterial recanalization as measured by changes in the presence of hyperdense artery sign (HAS) on initial and 24-hour computed tomography scans in patients treated with recombinant tissue plasminogen activator (rt-PA) or placebo, and to assess the effect of rt-PA on patient outcomes in this population. Methods: Patients in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial composed the study group. We determined the percentage of patients with HAS in rt-PA- and placebo-treated groups who had persistence (HAS +/+) or resolution (HAS +/-) of HAS on 24-hour computed tomography, and compared outcomes in those with resolution or persistence of the sign in these treatment groups. Results: Baseline HAS occurred in 79 of 604 eligible patients (13%). The two treatment groups were similar, although patients treated with rt-PA were significantly older. Of the 79 patients with HAS on baseline computed tomography scan, 14 of 37 (38%) treated with rt-PA had resolution of HAS at 24 hours compared with 7 of 42 (17%) treated with placebo (P = .03). Infarct volumes at 24 hours were significantly smaller in patients treated with rt-PA with resolution of the sign, compared with those who had persistence of the sign (P = .004). In our analysis, functional outcomes were not significantly improved based on resolution of HAS in either treatment group. There were 4 symptomatic ICHs in the rt-PA-treated group with HAS as compared with two in the placebo-treated group. Conclusion: Among patients with HAS at baseline in the NINDS rt-PA Stroke Trial, intravenous rt-PA increased recanalization as measured by resolution of HAS and reduced infarct volumes at 24 hours.

Original languageEnglish (US)
Pages (from-to)64-68
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume17
Issue number2
DOIs
StatePublished - Mar 2008

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Tissue Plasminogen Activator
Arteries
Tomography
Placebos
National Institute of Neurological Disorders and Stroke
Stroke
Therapeutics

Keywords

  • Acute stroke
  • hyperdense artery
  • recanalization
  • stroke volume
  • tissue plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Health Professions(all)

Cite this

@article{b4e9646af07942998e654654cb319f93,
title = "Intravenous Recombinant Tissue Plasminogen Activator Improves Arterial Recanalization Rates and Reduces Infarct Volumes in Patients With Hyperdense Artery Sign on Baseline Computed Tomography",
abstract = "Background: We sought to evaluate arterial recanalization as measured by changes in the presence of hyperdense artery sign (HAS) on initial and 24-hour computed tomography scans in patients treated with recombinant tissue plasminogen activator (rt-PA) or placebo, and to assess the effect of rt-PA on patient outcomes in this population. Methods: Patients in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial composed the study group. We determined the percentage of patients with HAS in rt-PA- and placebo-treated groups who had persistence (HAS +/+) or resolution (HAS +/-) of HAS on 24-hour computed tomography, and compared outcomes in those with resolution or persistence of the sign in these treatment groups. Results: Baseline HAS occurred in 79 of 604 eligible patients (13{\%}). The two treatment groups were similar, although patients treated with rt-PA were significantly older. Of the 79 patients with HAS on baseline computed tomography scan, 14 of 37 (38{\%}) treated with rt-PA had resolution of HAS at 24 hours compared with 7 of 42 (17{\%}) treated with placebo (P = .03). Infarct volumes at 24 hours were significantly smaller in patients treated with rt-PA with resolution of the sign, compared with those who had persistence of the sign (P = .004). In our analysis, functional outcomes were not significantly improved based on resolution of HAS in either treatment group. There were 4 symptomatic ICHs in the rt-PA-treated group with HAS as compared with two in the placebo-treated group. Conclusion: Among patients with HAS at baseline in the NINDS rt-PA Stroke Trial, intravenous rt-PA increased recanalization as measured by resolution of HAS and reduced infarct volumes at 24 hours.",
keywords = "Acute stroke, hyperdense artery, recanalization, stroke volume, tissue plasminogen activator",
author = "Christopher Nichols and Jane Khoury and Brott, {Thomas G} and Joseph Broderick",
year = "2008",
month = "3",
doi = "10.1016/j.jstrokecerebrovasdis.2007.10.002",
language = "English (US)",
volume = "17",
pages = "64--68",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Intravenous Recombinant Tissue Plasminogen Activator Improves Arterial Recanalization Rates and Reduces Infarct Volumes in Patients With Hyperdense Artery Sign on Baseline Computed Tomography

AU - Nichols, Christopher

AU - Khoury, Jane

AU - Brott, Thomas G

AU - Broderick, Joseph

PY - 2008/3

Y1 - 2008/3

N2 - Background: We sought to evaluate arterial recanalization as measured by changes in the presence of hyperdense artery sign (HAS) on initial and 24-hour computed tomography scans in patients treated with recombinant tissue plasminogen activator (rt-PA) or placebo, and to assess the effect of rt-PA on patient outcomes in this population. Methods: Patients in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial composed the study group. We determined the percentage of patients with HAS in rt-PA- and placebo-treated groups who had persistence (HAS +/+) or resolution (HAS +/-) of HAS on 24-hour computed tomography, and compared outcomes in those with resolution or persistence of the sign in these treatment groups. Results: Baseline HAS occurred in 79 of 604 eligible patients (13%). The two treatment groups were similar, although patients treated with rt-PA were significantly older. Of the 79 patients with HAS on baseline computed tomography scan, 14 of 37 (38%) treated with rt-PA had resolution of HAS at 24 hours compared with 7 of 42 (17%) treated with placebo (P = .03). Infarct volumes at 24 hours were significantly smaller in patients treated with rt-PA with resolution of the sign, compared with those who had persistence of the sign (P = .004). In our analysis, functional outcomes were not significantly improved based on resolution of HAS in either treatment group. There were 4 symptomatic ICHs in the rt-PA-treated group with HAS as compared with two in the placebo-treated group. Conclusion: Among patients with HAS at baseline in the NINDS rt-PA Stroke Trial, intravenous rt-PA increased recanalization as measured by resolution of HAS and reduced infarct volumes at 24 hours.

AB - Background: We sought to evaluate arterial recanalization as measured by changes in the presence of hyperdense artery sign (HAS) on initial and 24-hour computed tomography scans in patients treated with recombinant tissue plasminogen activator (rt-PA) or placebo, and to assess the effect of rt-PA on patient outcomes in this population. Methods: Patients in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial composed the study group. We determined the percentage of patients with HAS in rt-PA- and placebo-treated groups who had persistence (HAS +/+) or resolution (HAS +/-) of HAS on 24-hour computed tomography, and compared outcomes in those with resolution or persistence of the sign in these treatment groups. Results: Baseline HAS occurred in 79 of 604 eligible patients (13%). The two treatment groups were similar, although patients treated with rt-PA were significantly older. Of the 79 patients with HAS on baseline computed tomography scan, 14 of 37 (38%) treated with rt-PA had resolution of HAS at 24 hours compared with 7 of 42 (17%) treated with placebo (P = .03). Infarct volumes at 24 hours were significantly smaller in patients treated with rt-PA with resolution of the sign, compared with those who had persistence of the sign (P = .004). In our analysis, functional outcomes were not significantly improved based on resolution of HAS in either treatment group. There were 4 symptomatic ICHs in the rt-PA-treated group with HAS as compared with two in the placebo-treated group. Conclusion: Among patients with HAS at baseline in the NINDS rt-PA Stroke Trial, intravenous rt-PA increased recanalization as measured by resolution of HAS and reduced infarct volumes at 24 hours.

KW - Acute stroke

KW - hyperdense artery

KW - recanalization

KW - stroke volume

KW - tissue plasminogen activator

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U2 - 10.1016/j.jstrokecerebrovasdis.2007.10.002

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VL - 17

SP - 64

EP - 68

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

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