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J Neurol Neurosurg Psychiatry 2009;80:1156-1158 doi:10.1136/jnnp.2008.157313
  • Short report

Thrombolysis targeting MRI defined tissue at risk in minor stroke

  1. A Kruetzelmann1,
  2. S Siemonsen2,
  3. C Gerloff1,
  4. M Rosenkranz1,
  5. J Röther3,
  6. J Fiehler2,
  7. G Thomalla1
  1. 1
    Klinik und Poliklinik für Neurologie, Neuro-Zentrum, Hamburg, Germany
  2. 2
    Neuroradiologische Abteilung, Klinik und Poliklinik für Radiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  3. 3
    Neurologische Klinik, Klinikum Minden, Minden, Germany
  1. Correspondence to Dr A Christina Krützelmann, Neuro-Zentrum, Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraβe 52, D-20246 Hamburg, Germany; akruetzelmann{at}uke.uni-hamburg.de
  • Received 1 July 2008
  • Revised 20 October 2008
  • Accepted 21 October 2008

Abstract

Background: Treatment with intravenous tissue plasminogen activator (IV-tPA) is usually not recommended in patients with minor stroke. Clinical and imaging outcome were studied after IV-tPA treatment based on MRI criteria in patients with minor stroke.

Methods: Data were analysed retrospectively of acute ischaemic stroke patients with minor stroke (National Institutes of Health Stroke Scale (NIHSS) score <4). All patients were studied by stroke MRI including perfusion and diffusion weighted imaging (PWI and DWI) and treated with IV-tPA for ≤6 h. Final infarct volume was delineated on follow-up MRI. Clinical outcome was assessed after 90 days using the modified Rankin Scale (mRS).

Results: Six patients with a median NIHSS on admission of 2 (range 0–3) were treated with IV-tPA based on MRI criteria. In all patients, occlusion of the middle cerebral artery (MCA) was detected (MCA branch n = 2, MCA trunk n = 3, MCA trifurcation n = 1), and the PWI lesion (41, 25–60 ml) exceeded the DWI lesion (4, 1–23 ml). Final infarct volume was 9 (2–29) ml. Favourable outcome (mRS 0–1) was seen in 5/6 patients and independent outcome (mRS = 2) in one patient. No intracerebral haemorrhages occurred.

Conclusion: Treatment with IV-tPA based on MRI criteria was safe and appeared to be effective in this small series of patients with minor stroke.

Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was obtained.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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