Gonzalez, RamonFurie, K. L.Goldmacher, G. V.Smith, W. S.Kamalian, S.Payabvash, S.Harris, GordonHalpern, Elkan F.Koroshetz, W. J.Camargo, EricaDillon, W. P.Lev, Michael2017-05-152013Gonzalez, R. G., K. L. Furie, G. V. Goldmacher, W. S. Smith, S. Kamalian, S. Payabvash, G. J. Harris, et al. “Good Outcome Rate of 35% in IV-tPA-Treated Patients With Computed Tomography Angiography Confirmed Severe Anterior Circulation Occlusive Stroke.” Stroke 44 (11) (2013): 3109–3113.0039-2499http://nrs.harvard.edu/urn-3:HUL.InstRepos:32680055BACKGROUND AND PURPOSE: To determine the effect of intravenous tissue plasminogen activator (IV-tPA) on outcomes in patients with severe major anterior circulation ischemic stroke. METHODS: Prospectively, 649 patients with acute stroke had admission National Institutes of Health stroke scale (NIHSS) scores, noncontrast computed tomography (CT), CT angiography (CTA), and 6-month outcome assessed using modified Rankin scale. IV-tPA treatment decisions were made before CTA, at the time of noncontrast CT scanning, as per routine clinical protocol. Severe symptoms were defined as NIHSS>10. Poor outcome was defined as modified Rankin scale >2. Major occlusions were identified on CTA. Univariate and multivariate stepwise-forward logistic regression analyses of the full cohort were performed. RESULTS: Of 649 patients, 188 (29%) patients presented with NIHSS>10, and 64 out of 188 (34%) patients received IV-tPA. Admission NIHSS, large artery occlusion, and IV-tPA all independently predicted good outcomes; however, a significant interaction existed between IV-tPA and occlusion (P<0.001). Of the patients who presented with NIHSS>10 with anterior circulation occlusion, twice the percentage had good outcomes if they received IV-tPA (17 out of 49 patients, 35%) than if they did not (13 out of 77 patients, 17%; P=0.031). The number needed to treat was 7 (95% confidence interval, 3-60). CONCLUSIONS: IV-tPA treatment resulted in significantly better outcomes in patients with severely symptomatic stroke with major anterior circulation occlusions. The 35% good outcome rate was similar to rates found in endovascular therapy trials. Vascular imaging may help in patient selection and stratification for trials of IV-thrombolytic and endovascular therapies.en-UScomputed tomography angiography, ischemic stroke, thrombolysis, tissue plasminogen activator, treatment outcomeJournal Article2013-09-06Gonzalez, et al.10.1161/STROKEAHA.113.001938