Is Computed Tomography of the Brain Necessary after Thrombolytic Therapy in Acute Ischemic Stroke?
Julanon N, MD1,2, Vorasoot N, MD1,3, Kasemsap N, MD1,3, Tiamkao S, MD1, Sawanyawisuth K, MD, PhD1,2 Kongbunkiat K, MD1,3
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand 2 Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Research and Training Center for Enhancing Quality of Life of Working Age People, Khon Kaen University, Khon Kaen, Thailand 3 North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
Acute ischemic stroke is a public health issue worldwide. Currently, the effective treatment for acute ischemic stroke is an intravenous recombinant tissue plasminogen activator (rt-PA). The follow-up CT brain after the rt-PA is still controversial. This study was a retrospective study with an aim to evaluate roles of CT brain after rt-PA treatment. The inclusion criteria were all consecutive adult patients diagnosed as acute ischemic stroke who received the rt-PA. The patients were categorized into two groups by the presence of the follow-up CT brain. For those who performed the CT brain, results of the CT brain or management were correlated with clinical status at 24 hours after the rt-PA and stroke types. There were 211 eligible patients. Of those, 86 patients (40.76%) performed the CT brain after the rt-PA treatment within 24 to 36 hours. For the CT brain group, hemorrhagic transformation occurred the highest in those without clinical improvement with the NIHSS at 24 hours over 10 (14/32 patients; 43.75%). The overall hemorrhagic transformation was 23 patients (26.74%). Regarding stroke type, the intracerebral hemorrhage was found mostly in large arterial stroke (16 patients). While, the malignant middle cerebral artery infarction was found in seven patients (8.14%); five patients with large arterial stroke and two patients with cardioembolic stroke. In conclusion, the follow-up CT brain after the rt-PA treatment may be performed in selected cases such as those without clinical improvement with the NIHSS of over 10 or large arterial/cardioembolic stroke.
Keywords : Hemorrhagic transformation, rt-PA, Middle cerebral artery infarction
