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April 24, 2006

Is IV tissue plasminogen activator beneficial in patients with hyperdense artery sign?

A. I. Qureshi, MD, M. A. Ezzeddine, MD, A. Nasar, MS, M.F.K. Suri, MD, J. F. Kirmani, MD, N. Janjua, MD, and A. A. Divani, PhDAuthors Info & Affiliations

April 25, 2006 issue

66 (8) 1171-1174

https://doi.org/10.1212/01.wnl.0000208407.69544.5a

Abstract

Objective: To evaluate the effect of IV recombinant tissue plasminogen activator (rt-PA) in patients with hyperdense artery sign (HAS) on initial CT scan.

Methods: The authors determined the differential effect of IV rt-PA (0.9 mg/kg) in patients with HAS by testing the interaction of rt-PA and HAS in a logistic regression model after adjusting for age, sex, initial NIH Stroke Scale score (NIHSSS), time to randomization, systolic blood pressure, serum glucose, body temperature, and rt-PA in 616 patients treated within 3 hours of symptom onset. Outcomes evaluated included intracranial hemorrhage, modified Rankin scale (mRS) 0–1, Barthel Index (BI) of ≥ 95, Glasgow Outcome Scale (GOS) of 0–1, NIHSSS 0–1, and death at 90 days.

Results: HAS was detected on the initial CT scan in 91 (15%) of the 616 patients by an independent neuroradiologist. Significantly lower rates of mRS 0–1, BI ≥ 95, GOS of 0–1, or NIHSSS 0–1 at 90 days were observed among patients with HAS. IV rt-PA significantly increased the rates of mRS 0–1, BI ≥ 95, GOS of 0–1, or NIHSSS 0–1 at 90 days after adjusting for potential confounders without any significant modifying effect (interaction) of HAS. Among the 91 patients with HAS, rt-PA use demonstrated a trend or significance for increased adjusted rates of favorable outcomes by mRS (p = 0.04), BI (p = 0.1), GOS (p = 0.03), and NIHSSS (p = 0.01).

Conclusion: Although hyperdense artery sign is associated with poor outcome, IV recombinant tissue plasminogen activator may be beneficial in this subgroup of patients with ischemic stroke.

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Information & Authors

Information

Published In

Neurology^®

Volume 66 • Number 8 • April 25, 2006

Pages: 1171-1174

PubMed: 16636232

Copyright

© 2006.

Publication History

Published online: April 24, 2006

Published in print: April 25, 2006

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Authors

Affiliations & Disclosures

A. I. Qureshi, MD

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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M. A. Ezzeddine, MD

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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A. Nasar, MS

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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M.F.K. Suri, MD

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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J. F. Kirmani, MD

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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N. Janjua, MD

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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A. A. Divani, PhD

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

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Notes

Address correspondence and reprint requests to Dr. Adnan I. Qureshi, 90 Bergen Street, DOC–8100, Newark, NJ 07103; e-mail: [email protected]

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Cerebrovascular Disease/Stroke Clinical Trials Clinical trials observational study (cohort, case control)Imaging Infarction MRI

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