Methodology: 4/5
Usefulness: 3.5/5

Thomalla G, et al. Lancet. 2020 Nov 14;396(10262):1574-1584

Question and Methods: The authors evaluated the role of perfusion-imaging facilitated thrombolysis in strokes of unknown duration by way of a systematic review and individual patient data meta-analysis.
Findings: Perfusion-imaging facilitated thrombolysis improved neurological outcomes (mRS 0-1 at 90 days: 47 vs 39% [OR 1.49, 95% CI 1.10-2.03, P = 0.011] for tPA vs placebo).
Limitations: Trials reviewed were all stopped early, possibly introducing bias and 85% of perfusion imaging used was MRI, limiting applicability to a Canadian context.

Interpretation: Stroke care is evolving and becoming more nuanced; perfusion-imaging is likely to disrupt traditional time cut-offs for thrombolysis in the near future. 

By: Dr. Doran Drew

For all our other stroke related posts check out this link.

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.