A Study of Intravenous Thrombolysis With Alteplase in MRI-Selected Patients

Exclusion Criteria

• •History of intracranial hemorrhage
• •Symptoms rapidly improving or only minor before start of study drug.
• •Severe stroke as assessed clinically (e.g., NIHSS score \>25) or by appropriate imaging techniques (lesion volume \> one-third of MCA by visual inspection or \>100 cm3 using the ellipsoid estimation formula of ABC/2)
• •Stroke or serious head trauma within the previous 3 months
• •Administration of heparin within the 48 hours preceding the onset of stroke, with an activated partial-thromboplastin time at presentation exceeding the upper limit of the normal range
• •Platelet count of less than 100,000 per cubic millimeter
• •Uncontrolled hypertension defined as systolic blood pressure \> 185 mm Hg or diastolic blood pressure \> 110 mm Hg that cannot be controlled except with continuous parenteral antihypertensive medication
• •Blood glucose less than 50 mg per deciliter or greater than 400 mg per deciliter
• •Symptoms suggestive of subarachnoid hemorrhage, even if CT/MRI scan was normal
• •Oral anticoagulant treatment, regardless of INR.
• •Major surgery or severe trauma within the previous 3 months
• •Other major disorders associated with an increased risk of bleeding
• •Eligible for rt-PA therapy per institutional protocol as part of routine clinical practice
• •Non-ischemic etiology demonstrated by neuroimaging
• •Neuroimaging (CT or gradient echo MRI) evidence of acute or chronic ICH (non-microbleed)
• •Presence of 10 or more microbleeds on GRE (suggestive of amyloid angiopathy)
• •Any contraindication for MRI, e.g. presence of a pacemaker, ferromagnetic aneurysm clip, etc, pre-menopausal women with a positive pregnancy blood test, or severe claustrophobia.
• •Poor quality MRI- images are not interpretable
• •In the opinion of the investigator, the patient is not an appropriate candidate for IV rt-PA
• •Women known to be pregnant, lactating or having a positive or indeterminate pregnancy test.