Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke

Grant Mair, Zoe Morris, Anders von Heijne, Nick Bradey, Lesley Cala, André Peeters, Andrew J Farrall, Alessandro Adami, Gillian Potter, Geoff Cohen, Peter A G Sandercock, Richard I Lindley, Joanna M Wardlaw, IST-3 Collaborative Group, Gaetano Procaccianti

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3).

METHODS: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518).

RESULTS: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio [OR] 0.66, p < 0.001). Outcome was worse in patients with more (vs less) extensive HAS (OR 0.61, p = 0.027) but not in proximal (vs distal) HAS (p = 0.420). Increasing age was associated with more HAS growth at follow-up (OR 1.01, p = 0.013). Treatment with alteplase increased HAS shrinkage/disappearance at follow-up (OR 0.77, p = 0.006). There was no significant difference in HAS shrinkage with alteplase in proximal (vs distal) or more (vs less) extensive HAS (p = 0.516 and p = 0.580, respectively). There was no interaction between presence vs absence of HAS and benefit of alteplase on 6-month OHS (p = 0.167).

CONCLUSIONS: IV alteplase promotes measurable reduction in HAS regardless of HAS location or extent. Alteplase increased independence at 6 months in patients with and without HAS.

CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients within 6 hours of ischemic stroke with a CT hyperdense artery sign, IV alteplase reduced intra-arterial hyperdense thrombus.

Original languageEnglish
Pages (from-to)118-25
Number of pages8
JournalNeurology
Volume86
Issue number2
DOIs
Publication statusPublished - Jan 12 2016

Keywords

  • Aged
  • Aged, 80 and over
  • Arteries
  • Brain Ischemia
  • Female
  • Fibrinolytic Agents
  • Follow-Up Studies
  • Humans
  • Male
  • Stroke
  • Tissue Plasminogen Activator
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

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