Multimodal imaging does not delay intravenous thrombolytic therapy in acute stroke

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Acute ischemic stroke requires prompt treatment, with CT scans essential to exclude hemorrhage before administering IV tPA.
• Multimodal CT, including unenhanced CT, CTA, and PCT, was implemented to assess its impact on treatment timelines.

Purpose of the Study:

• To determine if multimodal CT imaging delays the initiation of IV tPA beyond 60 minutes from hospital arrival in acute ischemic stroke patients.

Main Methods:

• A retrospective analysis included patients with stroke alerts and symptom onset to arrival within 2.5 hours.
• Patients were divided into subgroups based on whether they received multimodal CT or unenhanced CT.
• Logistic regression identified predictors of tPA administration within 60 minutes.

Main Results:

• The median time to tPA was 56 minutes, with multimodal CT showing a shorter median time (55 minutes) compared to unenhanced CT (78 minutes).
• Prehospital stroke alerts, time to CT, and onset-to-arrival time were associated with timely tPA administration.
• No statistically significant difference in timely tPA odds was found between multimodal and unenhanced CT groups.

Conclusions:

• Multimodal imaging did not delay IV tPA administration beyond 60 minutes in this single-center study of acute stroke patients.
• Further research is necessary to confirm the routine feasibility of multimodal imaging in acute stroke care.