Can Intravenous Alteplase Tpa Be Given Safely In The Ct Scan Suite?

Background: In an effort to shorten door to needle times, stroke teams have moved towards injection of alteplase tPA (IVtPA) in the CT scan suite immediately after completion of the noncontrast CT, and before completion of the CTA. However, many stroke programs are prevented from initiating IVtPA in CT due to concerns about patient deterioration. We sought to determine the safety of this practice. Methods: 12 months of prospectively treated IVtPA cases from 2 comprehensive stroke centers were assembled for analysis. Cases were carefully examined to determine treatment location, and those treated inside the CT suite were selected for final review. Safety incidents were defined as those in which an IVtPA treated patient developed any condition requiring urgent or emergent management in the CT suite. sICH was defined as parenchymal hematoma type 2 in combination with a 4 or more point worsening on the NIHSS. Results: A total of 589 acute ischemic stroke patients were treated with IVtPA in calendar year 2016; of these 562 (95%) received their tPA bolus and start of infusion in the CT scan immediately after completion of the noncontrast CT, and prior to CTA. Zero safety incidents occurred in these cases. Additionally, there were no renal insults in the sample, despite not waiting for lab results prior to performing CTA. Median door to needle time was 22 minutes, and overall the sICH rate was 3% for the sample. Conclusions: Administration of IVtPA in the CT scan suite is safe and allows for faster administration of IVtPA. Use of this method should be adopted in a widespread manner to facilitate rapid early treatment of acute ischemic stroke.