Routine 24-Hour Computed Tomography Brain Scan is not useful in stable patients Post Intravenous Tissue Plasminogen...

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Current acute stroke guidelines recommend routine computed tomography (CT) brain scans 24 hours after intravenous tissue plasminogen activator (IV-tPA) treatment.
• The clinical utility of this routine neuroimaging in stable patients remains uncertain.
• This study investigated whether routine 24-hour post-treatment neuroimaging alters patient management.

Purpose of the Study:

• To evaluate the impact of routine 24-hour neuroimaging (CT or MRI) on the management of clinically stable patients treated with IV-tPA.
• To determine if routine post-treatment imaging is necessary for stable stroke patients.

Main Methods:

• Retrospective review of patients treated with IV-tPA between January 2011 and December 2013.
• Exclusion of patients who experienced neurological deterioration requiring neuroimaging.
• Abstracted data included demographics, neurological status changes, imaging results, and therapy modifications.

Main Results:

• Out of 131 included patients, 86.7% had moderate to severe initial neurological deficits.
• All patients underwent routine 24-hour neuroimaging (CT, MRI, or both).
• Only one patient (0.95%) experienced a change in management (a minor adjustment in blood pressure target) due to asymptomatic hemorrhagic transformation.

Conclusions:

• Routine 24-hour neuroimaging after IV-tPA in clinically stable stroke patients is associated with minimal changes in therapy.
• These findings suggest that routine neuroimaging may be safely omitted in stable patients.
• Avoiding routine imaging can reduce radiation exposure from CT scans and lower healthcare costs.