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Is IV tissue plasminogen activator beneficial in patients with hyperdense artery sign?

From Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark.

Address correspondence and reprint requests to Dr. Adnan I. Qureshi, 90 Bergen Street, DOC–8100, Newark, NJ 07103; e-mail: aiqureshi{at}hotmail.com

Objective: To evaluate the effect of IV recombinant tissue plasminogen activator (rt-PA) in patients with hyperdense artery sign (HAS) on initial CT scan.

Methods: The authors determined the differential effect of IV rt-PA (0.9 mg/kg) in patients with HAS by testing the interaction of rt-PA and HAS in a logistic regression model after adjusting for age, sex, initial NIH Stroke Scale score (NIHSSS), time to randomization, systolic blood pressure, serum glucose, body temperature, and rt-PA in 616 patients treated within 3 hours of symptom onset. Outcomes evaluated included intracranial hemorrhage, modified Rankin scale (mRS) 0–1, Barthel Index (BI) of 95, Glasgow Outcome Scale (GOS) of 0–1, NIHSSS 0–1, and death at 90 days.

Results: HAS was detected on the initial CT scan in 91 (15%) of the 616 patients by an independent neuroradiologist. Significantly lower rates of mRS 0–1, BI 95, GOS of 0–1, or NIHSSS 0–1 at 90 days were observed among patients with HAS. IV rt-PA significantly increased the rates of mRS 0–1, BI 95, GOS of 0–1, or NIHSSS 0–1 at 90 days after adjusting for potential confounders without any significant modifying effect (interaction) of HAS. Among the 91 patients with HAS, rt-PA use demonstrated a trend or significance for increased adjusted rates of favorable outcomes by mRS (p = 0.04), BI (p = 0.1), GOS (p = 0.03), and NIHSSS (p = 0.01).

Conclusion: Although hyperdense artery sign is associated with poor outcome, IV recombinant tissue plasminogen activator may be beneficial in this subgroup of patients with ischemic stroke.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 25 issue to find the title link for this article.

Disclosure: The authors report no conflicts of interest.

Received September 12, 2005. Accepted in final form January 3, 2006.

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