• T Nakashima, K Toyoda, M Koga, H Matsuoka, K Nagatsuka, T Takada, H Naritomi, and K Minematsu.
• Department of Medicine, National Cardiovascular Center; 5-7-1 Fujishirodai, Suita, Osaka, Japan. toyoda@ hsp.ncvc.go.jp
• Int J Stroke. 2009 Dec 1;4(6):425-31.

AimsTo determine the predictors of efficacy, including magnetic resonance imaging information, for low-dose intravenous alteplase therapy for stroke patients.MethodsSeventy-eight patients were prospectively enrolled in a single Stroke Unit (SU) receiving alteplase at a dose of 0.6 mg/kg during the initial 27 months after its approval in Japan. Ischaemic changes and vascular lesions were identified using computed tomography, diffusion-weighted magnetic resonance imaging, and magnetic resonance angiography. Early ischaemic signs were assessed using the Alberta Stroke Program Early CT Score.ResultsThe median baseline National Institutes of Health Stroke Scale score of 78 patients was 12. In 19 patients (24%), the National Institutes of Health Stroke Scale score improved by >or=8 points at 24 h. After multivariate adjustment, occlusion at the internal carotid artery (odds ratio 11.82, 95% confidence interval 1.73-142.74), Alberta Stroke Program Early CT Score on diffusion-weighted imaging ConclusionsIntravenous alteplase therapy at a dose of 0.6 mg/kg resulted in a relatively good overall outcome when compared with outcomes reported by western studies using an alteplase dose of 0.9 mg/kg. However, patients with occlusion at the internal carotid artery did not respond to this low-dose alteplase therapy.

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