02500nas a2200301   4500000000100000008004100001260001600042100001300058700001500071700001500086700001800101700001500119700001200134700001800146700001300164700001500177700001400192700001800206700001400224700001200238700001400250245009100264250001500355300001100370490000700381520175900388020005102147       2016                            d  c936255595171 aCohen G.1 aLindley R.1 aPeeters A.1 aSandercock P.1 aWardlaw J.1 aMair G.1 avon Kummer R.1 aAdami A.1 aFarrall A.1 aMorris Z.1 avon Heijne A.1 aBradey N.1 aCala L.1 aPotter G.00aEffect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke  a2015/12/15  a118-250 v863 a<p>
OBJECTIVE: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3). METHODS: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518). RESULTS: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio [OR] 0.66, p &lt; 0.001). Outcome was worse in patients with more (vs less) extensive HAS (OR 0.61, p = 0.027) but not in proximal (vs distal) HAS (p = 0.420). Increasing age was associated with more HAS growth at follow-up (OR 1.01, p = 0.013). Treatment with alteplase increased HAS shrinkage/disappearance at follow-up (OR 0.77, p = 0.006). There was no significant difference in HAS shrinkage with alteplase in proximal (vs distal) or more (vs less) extensive HAS (p = 0.516 and p = 0.580, respectively). There was no interaction between presence vs absence of HAS and benefit of alteplase on 6-month OHS (p = 0.167). CONCLUSIONS: IV alteplase promotes measurable reduction in HAS regardless of HAS location or extent. Alteplase increased independence at 6 months in patients with and without HAS. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients within 6 hours of ischemic stroke with a CT hyperdense artery sign, IV alteplase reduced intra-arterial hyperdense thrombus.
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  a1526-632X (Electronic)<br/>0028-3878 (Linking)