Efficacy and safety of CT perfusion-guided patient selection for intra-arterial thrombolysis of anterior circulation ischemic stroke beyond the time window

Objective To observe the safety and efficacy ofintra-arterial thrombolysis guided by CT perfusion in patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h.Methods The clinical data of patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h (n=36) and shorter than or equal to 6 h (n=30),performed intra-arterial thrombolysis in our hospitals from July 2003 to December 2012,were retrospectively evaluated.Patients of the former group were evaluated the ischemic penumbra and core region of infarction and the mismatch between the two regions based on CT perfusion.The clinical features,clinical outcomes and complications were compared between the two groups.Results As compared with those in patients of symptoms shorter than or equal to 6 h,the early neurological improvement rate (13.3％ vs.22.2％) and long-term neurological improvement rate (86.7％ vs.77.7％),recanalization rate (80.0％ vs.88.9％) and 3-month mortality (6.7％ vs.16.7％) of patients of symptoms longer than were not significantly different (P=0.665,P=0.665,P=0.639 and P=0.607).Conclusions To patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h,the neurological function at 3-month significantly improves after intra-arterial thrombolysis guided by CT perfusion.Although the incidence of symptomatic intracranial hemorrhage increases,the mortality rate does not significantly increase. Key words: Anterior circulation;  Ischemic stroke;  Intra-arterial thrombolysis;  Beyond the time window;  Computed tomography perfusion