Abstract: Objectives: To evaluate whether the outcome of IV-tPA Administration (ITA) time differs for each occluded vessel in acute ischemic stroke and to find prognostic predictors following ITA without endovascular treatment. Methods: We chose a cohort of only IV-tPA administered patients whose occluded vessel segments were confirmed by neuroimaging. ITA time, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Score (mRS), Early Neurological Improvement (ENI), Alberta Stroke Program Early CT (ASPECT) scores, infarct volumes, and collateral status were recorded. Results: Sixty-seven patients were included with 47 MCA (14 M1, 33 M2), 7 ACA, and 13 PCA occlusions. ROC analysis where time to ITA is the predictor showed poor discrimination (AUC values < 0.7) for prognosis. In PCA infarcts, ENI1 (NIHSS score improvement ≥ 4 points from baseline at 2 hours) was significantly associated ( P = 0.045) with ITA time. Higher infarct volume was significantly associated with lower odds of good mRS (1 and 3 months)/ENI4 (≥20% improvement from baseline NIHSS score at 24 hours), good collateral status had a significantly favorable outcome in the MCA, M2 and PCA segments. For each unit increase in ASPECT, the odds of good mRS (0-2 vs. 3-6) in 3 months increased by 2.01 (95% CI = 1.09 to 3.94, P = 0.031). Conclusions: Although the small sample size of PCA and ACA segment occlusion precluded the cut-off values of ITA time, other factors such as age, collateral status, infarct volume, and ASPECT score remain crucial alongside ITA timing. Limitations in this study include the small and imbalanced sample size and the single-center retrospective design, which may limit the generalizability of the results.
Işık et al. (Thu,) studied this question.
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