Intravenous Tissue Plasminogen Activator in Stroke Mimics

Area of Science:

• Neurology
• Emergency Medicine
• Pharmacology

Background:

• Rapid treatment of acute ischemic stroke with intravenous tissue-type plasminogen activator (tPA) is critical.
• However, administering tPA to patients with stroke mimics may increase risks, with limited safety data available.
• Stroke mimics present with stroke-like symptoms but are ultimately diagnosed with non-cerebrovascular conditions.

Purpose of the Study:

• To evaluate the safety and outcomes of tPA administration in patients with stroke mimics.
• To compare the characteristics and outcomes of tPA-treated stroke mimics versus those with true ischemic stroke.

Main Methods:

• Utilized data from the Get With The Guidelines-Stroke Registry (2010-2017) for 72,582 patients treated with tPA for suspected ischemic stroke.
• Identified and analyzed tPA use in stroke mimics (3.5% of cases) versus true ischemic strokes.
• Compared patient demographics, clinical characteristics, and in-hospital outcomes, including symptomatic intracranial hemorrhage, mortality, and discharge disposition.

Main Results:

• tPA-treated stroke mimics were younger, had less severe neurological deficits, and fewer cardiovascular risk factors than true stroke patients.
• The rate of symptomatic intracranial hemorrhage was significantly lower in stroke mimics (0.4%) compared to ischemic strokes (3.5%).
• In-hospital mortality was lower in stroke mimics (0.8% vs. 6.2%), with higher rates of discharge home and independent ambulation.

Conclusions:

• The study found low complication rates associated with tPA administration in stroke mimics.
• Despite potential risks, the data suggest a relatively safe profile for tPA in this population.
• Continued improvement in rapid and accurate diagnosis is essential for optimizing acute ischemic stroke treatment.