Acute ischemic stroke is a public health issue worldwide. Currently, the effective treatment for acute ischemic stroke is an intravenous recombinant tissue plasminogen activator (rt-PA). The follow-up CT brain after the rt-PA is still controversial. This study was a retrospective study with an aim to evaluate roles of CT brain after rt-PA treatment. The inclusion criteria were all consecutive adults patients diagnosed as acute ischemic stroke who received the rt-PA. The patients were categorized into two groups by the presence of the follow-up CT brain. For those who performed the CT brain, results of the CT brain or management were correlated with clinical status at 24 hours after the rt-PA and stroke types. There were 211 eligible patients. Of those, 86 patients (40.76%) performed the CT brain after the rt-PA treatment within 24-36 hours. For the CT brain group, hemorrhagic transformation occurred in highest in those without clinical improvement with the NIHSS at 24 hours over 10 (14/32 patients; 43.75%). The overall hemorrhagic transformation was 23 patients (26.74%). Regarding stroke type, the intracerebral hemorrhage was found mostly in large arterial stroke (16 patients) While, the malignant middle cerebral artery infarction was found in seven patients (8.14%); five patients in large arterial stroke and two patients in cardioembolic stroke. In conclusion, the follow-up CT brain after the rt-PA treatment may be performed in selected cases such as those without clinical improvement with the NIHSS of over 10 or large arterial/cardioembolic stroke.

Keywords: hemorrhagic transformation; rt-PA; middle cerebral artery infarction