Article Text

Download PDFPDF
Prognostic value of acute CT in stroke thrombolysis
  1. Keith W Muir
  1. Neurology, University of Glasgow, Glasgow, Glasgow, UK
  1. Correspondence to Professor Keith W Muir, Institute of Neuroscience & Psychology, University of Glasgow, Glasgow G12 8QQ, UK; Keith.Muir{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

How do pre-thrombolysis CT scan appearances in acute stroke aid prognosis? Insights from the ENCHANTED trial

In acute stroke, CT scanning was the predominant imaging modality in clinical trials of thrombolysis and thrombectomy. While CT reliably excludes intracranial haemorrhage and some structural stroke mimics, the inherently slow decrease in X-ray attenuation over the hours after stroke onset limits the sensitivity of CT to acute ischaemia. Interpretation of subtle early ischaemic changes is confounded by common background abnormalities including atrophy, old infarcts or haemorrhage, and rarefaction of cerebral white matter due to chronic ischaemia (leukoaraiosis). In this issue, the ENCHANTED investigators report associations of both acute ischaemia and background ‘brain frailty’ on pre-thrombolysis CT with clinical outcomes in a large clinical trial.1

ENCHANTED compared standard dose alteplase with a lower dose regime that is widely used in south-east …

View Full Text


  • Contributors I am the sole author.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests I have received fees for participation in advisory boards for Boehringer Ingelheim, Biogen, ReNeuron, Bayer and Daiichi Sankyo. I am the chief investigator for the ATTEST-2 trial, which receives support from Boehringer Ingelheim for tenecteplase supply. I hold grants with Profs Wardlaw and Robinson and Dr Mair and serve on trial steering committees with these investigators. Prof Lindley chairs the independent Data Monitoring Committee for the ATTEST-2 trial.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

  • Cerebrovascular disease
    Candice Delcourt Xia Wang Zien Zhou Joanna M Wardlaw Grant Mair Thompson G Robinson Xiaoying Chen Sohei Yoshimura Takako Torii-Yoshimura Cheryl Carcel Zeljka Calic Wee Yong Tan Alejandra Malavera Craig S Anderson Richard I Lindley