The Association Between Brain CT Signs And Prognosis Of Alteplase Intravenous Thrombolysis Therapy In Patients With Acute Ischemic Stroke

Background and objective:It is essential for patients with acute ischemic stroke onset within 3-4.5 hours to conduct brain imaging examination before intravenous thrombolysis therapy. However,present studies show that patients with early ischemic signs on brain CT have increased risk of symptomatic intracranial haemorrhage after thrombolysis therapy, and little information is available about whether pre-existing structural signs, which are common in older patients, affect response to alteplase. We aimed to investigate the association between imaging signs on brain CT and outcomes after alteplase.Methods:Patients with acute ischemic stroke treated with intravenous thrombolysis were prospectively registered in the Thrombolysis Implementation and Monitor of acute ischemic Stroke in China. Brain scans(CT or MRI) have been completed before thrombolysis therapy and then been sent to TIMS-China study centre for adjudication.Experts who were unaware of the random allocation assessed scans for early signs of ischaemia(tissue hypoattenuation, infarct extent, swelling, and hyperattenuated artery)and pre-existing signs(old infarct, leukoaraiosis, atrophy and intracranial arterial calcification). Patients who with incomplete date,more than 4.5-hour treatment time window,Posterior circulation infarction and poor image quality were excluded. Then we assessed the interactions between these imaging signs, symptomatic intracranial haemorrhage and independence at 3months(mRS0-1).Results :525 patients were included in our analysis, of whom 241(54.90%)have good functional outcome at 3 month and 284(54.10%)with poor functional outcome at month.Tissue hypoattenuation(OR,0.61;95%CI,0.41-0.93),large infarct(OR,0.33;95%CI,0.12-0.92),hyperattenuated artery(OR,0.33;95%CI,0.16-0.68)predicted a reduction in independence. Symptomatic intracranial haemorrhage was predicted by no one image sign. The existence of large infart(OR,5.26;95%CI,1.92-14.42),hyperattenuated artery(OR,3.61;95%CI,1.60-8.18),atrohpy(OR,4.66;95%CI,1.10-19.63) increase the mortality at 3 month.Conclusion :Tissue hypoattenuation,large infarct and hyperattenuated artery were related to poor clinical outcome at 3 month, but only hyperattenuated artery was independent predictor of poor clinical outcome at 3 month.Brain atrophy on pre-thrombolysis brain CT is associated with increased risk of death at 3 month.