Abstract Details

Title Targets for Thrombolysis in Stroke Patients who Present in an Extended Time Window

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S57 - Acute Treatment and Imaging of Ischemic Stroke (1:55 PM-2:06 PM)

Poster/Presentation
Number 006

Background Recent studies have found that patients presenting up to 24 hours after stroke onset have penumbral tissue on multimodal imaging that benefits from endovascular therapy. Stroke patients presenting in this time window without a large vessel occlusion (LVO) currently have no treatment options.

Objective To determine the number of stroke patients presenting in an extended time window who have an MRI target for treatment with thrombolysis.

Design/Methods Patients admitted to our two institutions from the beginning of 2011 to the end of 2015 were reviewed to identify patients who presented >4 hours and <24 hours from last seen normal (LSN) and did not receive acute treatment. MRI scans performed during the 4-to-24-hour window were reviewed for the presence of hemorrhagic transformation, stroke on diffusion weighted imaging (DWI) and blood flow deficit on perfusion weighted imaging (PWI). The diffusion-perfusion mismatch was judged based on visual inspection.

Results During the study period, 3469 patients were evaluated by our stroke service, 2804 had a documented time LSN, and 893 patients were evaluated between 4 and 24 hours after LSN and did not received an acute treatment. MRI was performed in 606 of these patients and 450 had DWI and PWI allowing for assessment of a mismatch. Eight patients had some degree of hemorrhagic transformation of their acute stroke. Of the remaining 442 patients, 13 patients had and LVO target for endovascular therapy. This left 429 patients who presented without any current treatment options. Of these, 318 (74%) demonstrated a mismatch between their DWI lesion and their PWI lesion and thus had a potential target for reperfusion therapy. Thus, of the 606 patients evaluated with MRI in the extended time window, 52% had a mismatch.

Conclusions Approximately half of stroke patients who present outside of thrombolysis treatment time windows without a LVO may benefit from reperfusion therapy.

Authors/Disclosures
Parisa Heidari, MD PRESENTER	Dr. Heidari has nothing to disclose.
	No disclosure on file
	No disclosure on file
Richard Leigh, MD (Johns Hopkins University)	The institution of Dr. Leigh has received research support from National Institutes of Health. The institution of Dr. Leigh has received research support from American Heart Association. Dr. Leigh has received intellectual property interests from a discovery or technology relating to health care.

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