Transient ischemic attack after tissue plasminogen activator: aborted stroke or unnecessary stroke therapy?

BACKGROUND: The frequency with which intravenous thrombolysis for acute ischemic stroke results in normal clinical and radiographic status is currently unknown.

METHODS: Patients who received intravenous thrombolysis at community hospitals and a stroke center were retrospectively analyzed for occurrence of normal imaging after tissue plasminogen activator (tPA) treatment. The cases were classified as nonischemic process (stroke mimic), transient ischemic attack (TIA) or ischemic stroke. The occurrence rate and predictors of each condition were sought.

RESULTS: Of 254 patients who received tPA, 9 (3.5%) had a nonischemic process, 23 (9.1%) had TIA, and 222 (87%) were diagnosed with ischemic stroke. Nonischemic process patients were younger and were more likely to have received tPA at a community hospital than those with TIA or stroke. TIA was associated with lower pretreatment serum glucose, prevalence of coronary artery disease and stroke severity but not to time to treatment.

CONCLUSION: Over 10% of patients who receive tPA for cerebral ischemia do not develop ischemic injury. tPA use for a nonischemic process is infrequent but is associated with community hospital use.