Introduction: Current AHA/ASA guidelines recommend administration of tissue plasminogen activator (t-PA) for ischemic stroke (IS) with a door-to-needle time of 60 minutes or less, which sometimes results in administering intravenous t-PA in patients with alternative diagnoses such as stroke mimics and transient ischemic attacks. The goal of this study was to determine the incidence of negative neuroimaging for IS in our acute stroke registry patients who received IV t-PA. Secondary outcomes included the incidence of stroke mimics and complications following t-PA therapy.
Hypothesis: We anticipate that the complication rate of administering IV t-PA in IS patients with negative neuroimaging and stroke mimics will be minimal.
Methods: Patients who received IV t-PA for acute IS at our primary stroke center from January 2012 through December 2014 were selected. Data were collected via retrospective chart review.
Results: We identified144 patients who received IV t-PA, of which 74 (51%) were diagnosed with an IS and 35 (24%) with a stroke mimic, 21 (15%) with TIA and 14 (10%) with negative neuroimaging IS. Baseline risk factors, race and gender were similar between all four groups. Overall 78.5% of patients were Caucasian, 60.4% were female and the mean total risk factors were 3.47. We found a significant difference between ages of patients with stroke mimics compared to patients with TIA (53.6 years versus 76.4, respectively, p-value < 0.01), but no statistic difference between negative neuroimaging IS and neuroimaging confirmed IS (71.1 and 72.1 years, respectively). Additionally, patients with confirmed IS had higher NIHSS scores at admission compared to patients with stroke mimic, TIA and negative neuroimaging IS (9.75 versus 5.67, 4.00 and 5.05 respectively, p-value < 0.01). Symptomatic ICH occurred in 7 (9.5%) of the confirmed IS patients, of which 4 led to death. There were no cases of symptomatic ICH in the other groups.
Conclusions: Overall 49% of patients were found to have negative imaging. Our study supports the safety of IV t-PA administration in neuroimaging negative strokes and stroke mimics. Future studies are needed to look at outcomes such as discharge disposition, need for rehabilitative services and mRS scores up to 12 months following discharge.