Objective: To explore the efficacy and safety of intravenous thrombolysis (IVT) directed by whole-brain computed tomographic perfusion (CTP).
Methods: A total of 65 patients with acute ischemic stroke at our hospital during the period of April 2011 to April 2013, selected in accordance with the established CTP or TTW standard (0 to 3.0 h and 3.0 to 4.5 h) for IVT were included for analysis. The primary endpoint events were Barthel index (BI) and the rate of serious adverse events at 14 days post-onset. The latter included mortality and symptomatic intracerebral hemorrhage (ICH). And secondary indicators included the incidence of reperfusion, recanalization, ICH and neurological improvement at Day 14, as well as time indicators, such as onset-to-door time (ODT), door-to-treatment time (DTT) and onset-to-treatment time (OTT). Statistical calculations for continuous variables were compared with t or Mann-Whitney U test. And other comparisons were made with Pearson Chi-square or Fisher's exact test.
Results: Twenty-five and 40 cases with acute ischemic stroke were enrolled according to CTP or TTW standard for IVT respectively. Baseline characteristics, including age, gender, risk factors, blood pressure, blood sugar, National Institute of Health stroke scale (NIHSS) and drug dose showed no significant difference among groups. DTT and OTT in CTP group were significantly longer than those of the 0 to 3.0 h subgroup, while similar with those of the 3.0 to 4.5 h subgroup. Interestingly, consistent with a significant higher rate of transferring for consultation in the CTP group comparing with the TTW group (52.0% vs 25.0%, P = 0.03), the rate was also significantly higher than the 0 to 3.0 h subgroup (52.0% vs 7.7%, P = 0.02), but not significantly higher than the 3.0 to 4.5 subgroup. Both primary endpoint events and secondary outcome measures among three groups showed no significant differences. As for secondary outcome measures, CTP group had a higher recanalization than the 3.0 to 4.5 h subgroup (52.0% vs 37.0%, P = 0.28) and there was a trend toward significance. CTP excluded 58 cases, including 20 proved cases of malignant infarction on magnetic resonance imaging.
Conclusion: CTP is able to select reasonable candidates for IVT in an extended time window with effectiveness and safety comparable to TTW standard. Furthermore, it is quicker and more sensitive than TTW standard in detecting malignant infarction.