1
|
Qin B, Fu L, Qin H, Liang Y, Qin C, Zhang J, Gao W. Intravenous thrombolysis versus dual antiplatelet therapy for patients with acute minor ischaemic stroke: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1377475. [PMID: 38915465 PMCID: PMC11194400 DOI: 10.3389/fphar.2024.1377475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Background and purpose The efficacy of intravenous thrombolysis (IVT) in patients with acute minor ischaemic stroke (AMIS) remains unclear. We performed a meta-analysis to compare the efficacy and safety of IVT and dual antiplatelet therapy (DAPT) in patients with AMIS. Methods The Embase, Cochrane Library, PubMed, and Web of Science databases were searched up to 10 October, 2023. Prospective and retrospective studies comparing the clinical outcomes of IVT and DAPT were included. Odds ratios (ORs) and 95% confidence intervals (CIs) for early neurological deterioration (END), excellent and favourable functional outcomes, recurrent ischaemic stroke at 3 months, mortality at 3 months, and symptomatic intracranial haemorrhage (ICH) were pooled using a random-effects model. Results Of the five included studies, 6,340 patients were included. In patients with AMIS, IVT was not significantly associated with excellent and favourable functional outcomes, recurrent ischaemic stroke, or all-cause mortality at 3 months compared to early DAPT. However, a higher risk of symptomatic ICH (OR, 9.31; 95% CI, 3.39-25.57) and END (OR, 2.75; 95% CI, 1.76-4.30) were observed with IVT. Conclusion This meta-analysis indicated that IVT was not superior to DAPT in patients with AMIS, especially in those with nondisabling AIS. However, these findings should be interpreted with caution and have some limitations. Further, well-designed randomised controlled trials are warranted.
Collapse
Affiliation(s)
- Bin Qin
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lin Fu
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Huixun Qin
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Yuming Liang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Cheng Qin
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Jiede Zhang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Wen Gao
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| |
Collapse
|
2
|
Cao X, Luo J, Xu B, Xiao Y, Yang T, Sun X, Sui Y. Best medical management versus intravenous thrombolysis for mild non-disabling ischemic stroke: A prospective noninferiority registry study. J Neurol Sci 2023; 451:120706. [PMID: 37379725 DOI: 10.1016/j.jns.2023.120706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES The efficacy and safety of intravenous thrombolysis uncertain in patients with non-disabling mild ischemic stroke. Our aim was to investigate whether best medical management only is noninferior to intravenous thrombolysis plus best medical management therapy for achieving favorable functional outcome at 90 days. MATERIALS AND METHODS In a prospective acute ischemic stroke registry from 2018 through 2020, 314 non-disabling mild ischemic stroke patients received best medical management only and 638 underwent intravenous thrombolysis plus best medical management. The primary outcome was modified Rankin Scale ≤1 at Day 90. The noninferiority margin was -5%. Secondary outcomes of hemorrhagic transformation, early neurologic deterioration and mortality were also evaluated. RESULTS The best medical management only was noninferior to the combined therapy of intravenous thrombolysis and best medical management with regard to the primary outcome (unadjusted risk difference, 1.16%; 95% CI, -3.48% ∼ 5.8%; p = 0.0046 for noninferiority; adjusted risk difference, 3.01%; 95% CI, -3.39% ∼ 9.41%). After propensity score matching, p < 0.0001 for noninferiority. RD, 4.03%; 95% CI, -1.59% ∼ 9.69%. p < 0.0001 for noninferiority. Adjusted RD, 5.23%; 95% CI, -1.88% ∼ 9.97%. The occurrence of hemorrhagic transformation was significantly increased in the group of combination therapy (OR, 4.26; 95% CI, 1.30 to 13.99; p = 0.008), while no significant difference was detected in early neurologic deterioration (OR, 1.11; 95% CI, 0.49-2.52; p = 0.808) and mortality (OR, 0.57; 95% CI, 0.20 to 1.69; p = 0.214) between groups. CONCLUSIONS In the present study, we found the best medical management only was noninferior to the combination therapy of intravenous thrombolysis plus best medical management for non-disabling mild ischemic stroke within 4.5 h after onset. Best medical management may be a treatment of choice for non-disabling mild ischemic stroke patients. Further randomized controlled studies are warranted.
Collapse
Affiliation(s)
- Xiaopan Cao
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, 4 Chongshandong Road, Huanggu District, Shenyang 110004, Liaoning, China; Department of Neurology and Neuroscience, Shenyang First People's Hospital, Shenyang Brain Hospital, Shenyang Brain Institute, 67 Qingquan Road, Dadong District, Shenyang 110041, Liaoning, China.
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, 223 Handan Road, Yangpu District, Shanghai 200436, China.
| | - Bing Xu
- Department of Neurology and Neuroscience, Shenyang First People's Hospital, Shenyang Brain Hospital, Shenyang Brain Institute, 67 Qingquan Road, Dadong District, Shenyang 110041, Liaoning, China
| | - Ying Xiao
- Department of Neurology and Neuroscience, Shenyang First People's Hospital, Shenyang Brain Hospital, Shenyang Brain Institute, 67 Qingquan Road, Dadong District, Shenyang 110041, Liaoning, China
| | - Tuo Yang
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, 4 Chongshandong Road, Huanggu District, Shenyang 110004, Liaoning, China
| | - Xiaohong Sun
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, 4 Chongshandong Road, Huanggu District, Shenyang 110004, Liaoning, China.
| | - Yi Sui
- Department of Neurology and Neuroscience, Shenyang First People's Hospital, Shenyang Brain Hospital, Shenyang Brain Institute, 67 Qingquan Road, Dadong District, Shenyang 110041, Liaoning, China.
| |
Collapse
|
3
|
Retinal Infarction: A Pilot Study on the Efficacy and Safety of Intravenous Thrombolysis and Underlying Aetiologies. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081279. [PMID: 36013458 PMCID: PMC9409746 DOI: 10.3390/life12081279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/15/2022] [Accepted: 08/17/2022] [Indexed: 01/10/2023]
Abstract
Background: Treatment of non-arteritic central retinal artery occlusion is still inconsistent. Therefore, the current study aimed to evaluate the efficacy of intravenous thrombolysis (IVT) and describe the prevalence of co-occurring ischemic brain lesions in patients with acute visual loss due to ischemia. Methods: We analysed 38 consecutive patients with acute visual loss between January 2015 and June 2020. Patients presenting within 4.5 h of symptom onset without any contraindication were treated with IVT. Patients underwent neurologic and ophthalmologic examination and diagnostic workup for the underlying aetiology. Follow-up was performed after 3 and 12 months. Results: Patients treated with IVT had a significantly better functional outcome at discharge compared to patients treated conservatively. No additional ischemic brain lesions were detected (0 of 38). Three patients had extracranial carotid artery stenosis ≥50%. Atrial fibrillation was present in four patients, three of whom already received oral anticoagulation. In the remaining 31 patients no embolic source was detected. However, the number of plaques were rated mild to moderate. Within three months, one patient developed transient visual loss while another suffered a contralateral transient ischemic attack. Conclusions: IVT may represent a safe and effective treatment option in patients with isolated visual loss due to ischemia. The aetiology was atherosclerotic burden rather than embolism caused by carotid stenosis or atrial fibrillation, bringing the current diagnostic procedure and therapy into question. Randomized trials are necessary to evaluate the efficacy and safety of IV thrombolysis and clarify the aetiology of isolated visual loss due to ischemia.
Collapse
|
4
|
Hu Y, Zheng H, Chen X, Gao Z. Rt-PA thrombolytic therapy in patients with acute posterior circulation stroke: A retrospective study. MEDICINE INTERNATIONAL 2022; 2:8. [PMID: 36699100 PMCID: PMC9829197 DOI: 10.3892/mi.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 02/01/2023]
Abstract
At present, recombinant tissue-type plasminogen activator (rt-PA) thrombolytic therapy is widely used in patients with acute ischemic stroke within 4.5 h following stroke onset. However, the efficacy of intravenous alteplase thrombolytic therapy for posterior circulation stroke (PCS) has been rarely described. The present study aimed to predict the outcome of patients with PCS following rt-PA thrombolytic therapy in a more efficient manner. Data were collected from patients who had suffered from posterior circulation ischemic stroke, who had been treated with rt-PA over a period of 4 years (2016-2020), and had been treated at a stroke center. All patients were treated with alteplase at a standard dose of 0.9 mg/kg. According to the onset to needle time (ONT), these patients were divided into the 0-3 and 3-4.5 h groups, and the National Institutes of Health Stroke Scale (NIHSS) score was compared before thrombolysis and at 24 h after thrombolysis. Subsequently, the patients with acute PCS whose ONT was ≤3 h were divided into the NIHSS score >3 points and NIHSS score ≤3 points groups, and the NIHSS score improvement rate was compared 24 h later. A total of 989 patients were included in the study; there were 783 patients with acute anterior circulation stroke (ACS) and 203 patients with acute PCS (of note, 2 patients had negative results from brain magnetic resonance imaging); 63 patients were treated with urokinase (UK) thrombolysis and 140 patients were treated with alteplase intravenous thrombolysis. The 140 patients that received alteplase thrombolytic therapy were divided into two groups, namely the ≤3 h group and 3-4.5 h group, which, on the basis of the ONT, no significant differences were found between the two the groups according to the NIHSS score before thrombolysis (P>0.05). The NHISS scores in the ≤3 h group were significantly lower than those in the 3-4.5 h group following thrombolysis therapy, and the differences between the two groups were statistically significant (P<0.05); the patients with acute PCS treated with rt-PA in the ≤3 h group were divided into the NIHSS score ≤3 points group and the NIHSS score >3 points group. In this ≤3 h group, the average NIHSS score improvement rate following rt-PA thrombolysis was 0.535 (53.5%) in the NIHSS score ≤3 points group and that in the NIHSS score >3 points group was 0.336 (33.6%); the difference between the two groups was statistically significant (P<0.05). The patients treated with intravenous alteplase thrombolysis within 3 h following stroke onset benefited more than those treated with thrombolysis therapy within 3 to 4.5 h after stroke onset. On the whole, the present study demonstrates that the patients with mild stroke (NIHSS score ≤3 points) who were treated at an earlier stage (received alteplase thrombolysis therapy within 3 h after stroke onset) benefited to a greater extent from the therapy.
Collapse
Affiliation(s)
- Yaozhi Hu
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P.R. China
| | - Haifei Zheng
- Department of International Special Needs Medicine, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P.R. China
| | - Xiaohui Chen
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P.R. China
| | - Zongen Gao
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P.R. China.,Department of Cardiovascular and Cerebrovascular Institute, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P.R. China
| |
Collapse
|
5
|
Tang H, Yan S, Wu C, Zhang Y. Characteristics and Outcomes of Intravenous Thrombolysis in Mild Ischemic Stroke Patients. Front Neurol 2021; 12:744909. [PMID: 34777212 PMCID: PMC8586409 DOI: 10.3389/fneur.2021.744909] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/28/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: This study assessed the characteristics of intravenous thrombolysis (IVT) with respect to early neurological deterioration (END) and functional outcome in mild ischemic stroke patients. Methods: Data were obtained from acute mild ischemic stroke patients (defined as having a National Institute of Health Stroke Score (NIHSS) ≤ 5) treated with IVT in our hospital from July 2017 to December 2020. END was defined as the NIHSS increased ≥1 over the baseline at 24 h after IVT. A modified Rankin scale (mRS) ≤ 1 at 3 months was considered as a favorable outcome, and an mRS ≥2 at 3 months was an unfavorable outcome. Results: Two hundred thirty-three acute mild ischemic stroke patients (all patients underwent MRI and DWI restriction) with IVT were included in this study. Thirty-one patients experienced END, and 57 patients experienced an unfavorable outcome at 3 months. With multivariate analysis, END was associated with an elevated baseline systolic blood pressure (SBP) (OR = 1.324, 95% CI, 1.053–1.664, p = 0.016) and coronary heart disease (OR = 4.933, 95% CI, 1.249–19.482, p = 0.023). An unfavorable outcome at 3 months after IVT was independently associated with a baseline elevated SBP (OR = 1.213, 95% CI, 1.005–1.465, p = 0.045), baseline NIHSS (OR = 1.515, 95% CI, 1.186–1.935, p = 0.001), prior hyperlipemia (OR = 3.065, 95% CI, 1.107–8.482, p = 0.031), cardioembolic stroke (OR = 0.323, 95% CI, 0.120–0.871, p = 0.025), and END at 24 h (OR = 4.531, 95% CI, 1.950–10.533, p < 0.001) in mild ischemic stroke patients. Conclusion: In mild ischemic stroke patients with IVT, an elevated baseline SBP and coronary heart disease were associated with END. The elevated baseline SBP, baseline NIHSS, a history of prior hyperlipemia, cardioembolic stroke, and END at 24 h after IVT were useful in predicting an unfavorable outcome at 3 months.
Collapse
Affiliation(s)
- Huan Tang
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Shenqiang Yan
- Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chenglong Wu
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Yanxing Zhang
- Department of Neurology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| |
Collapse
|
6
|
Schultheiss M, Spitzer MS, Hattenbach LO, Poli S. [Update on intravenous lysis treatment : The REVISION trial]. Ophthalmologe 2021; 118:1107-1112. [PMID: 34351478 DOI: 10.1007/s00347-021-01467-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND To date, no evidence-based treatment for acute non-arteritic central retinal artery occlusion (CRAO) exists. Considering the limited ischemia tolerance of the retina and the results of multiple case series, increasing expectations are directed towards an early intravenous thrombolysis within 4.5 h after CRAO onset. OBJECTIVE The current literature regards timely retinal reperfusion as the only potentially beneficial therapeutic option to treat non-arteritic CRAO. Available data on the efficacy and safety of thrombolysis in CRAO are presented and discussed. On the basis of these data, the prospective, randomized, double-blind, placebo-controlled REVISION trial (early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion) will shortly be initiated in 25 centers across Germany in order to investigate early intravenous thrombolysis in acute CRAO. The main inclusion criteria of the REVISION trial are outlined, which may help ophthalmologists to identify study candidates and facilitate rapid referral to a study center. CONCLUSION The efficacy of intravenous thrombolysis in acute ischemic stroke is critically time dependent. This may also be assumed in acute CRAO; however, definite evidence still needs to be provided. Until then, the motto "time is retina" should be applied and intravenous thrombolysis should be offered to CRAO patients as part of randomized trials (such as REVISION). According to the current literature, other acute treatment approaches (such as paracentesis) are not indicated.
Collapse
Affiliation(s)
- Maximilian Schultheiss
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin S Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | | | - Sven Poli
- Hertie-Institut für klinische Hirnforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen, Universitätsklinikum Tübingen, Tübingen, Deutschland
| |
Collapse
|
7
|
Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis. Brain Sci 2021; 11:brainsci11070945. [PMID: 34356179 PMCID: PMC8306755 DOI: 10.3390/brainsci11070945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/24/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The benefit of alteplase in minor non-disabling acute ischemic stroke (AIS) is unknown. We aimed to explore the clinical efficacy of alteplase-treatment in minor non-disabling stroke in clinical practice. Methods: We used a prospectively collected database of AIS patients who were being assessed for thrombolysis with alteplase. Minor non-disabling AIS was identified as patients with baseline National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 and a score 0 or 1 on each baseline NIHSS score item (items 1a to 1c being 0). Results: A total of 461 patients with minor non-disabling AIS were included and among them 240 (52.1%) patients were treated with alteplase and 113 (24.5%) patients had severe stenosis/occlusion of large vessels. No significant association of 90-day excellent outcome was found with alteplase-treatment (77.1% vs. 80.5%, p 1 = 0.425; OR 0.911, 95% CI 0.428 to 1.940; p 2 = 0.808). However, among patients with severe stenosis/occlusion of large vessels, alteplase-treatment was independently associated with excellent outcome (74.4% vs. 45.7%, p 1 = 0.005; OR 4.709, 95% CI 1.391 to 11.962; p 2 = 0.010). Conclusion: Although alteplase-treatment did not result in an excellent outcome in general minor non-disabling stroke patients, it may work in those specific patients who had severe stenosis/occlusion of large vessels.
Collapse
|
8
|
Lei Z, Li S, Feng H, Lai Y, Zhou Y, Li C, Ren L. Prognostic nomogram for patients with minor stroke and transient ischaemic attack. Postgrad Med J 2020; 97:644-649. [PMID: 32917776 DOI: 10.1136/postgradmedj-2020-137680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/22/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ischaemic stroke and transient ischaemic attack (TIA) share a common cause. We aim to develop and validate a concise prognostic nomogram for patients with minor stroke and TIA. METHODS A total of 994 patients with minor stroke and TIA were included. They were split into a derivation (n=746) and validation (n=248) cohort. The modified Rankin Scale (mRS) scores 3 months after onset were used to assess the prognosis as unfavourable outcome (mRS≥2) or favourable outcome (mRS<2). RESULT The final model included seven independent predictors: gender, age, baseline National Institute of Health Stroke Scale (NIHSS), hypertension, diabetes mellitus, white blood cell and serum uric acid. The Harrell's concordance index (C-index) of the nomogram for predicting the outcome was 0.775 (95% CI 0.735 to 0.814), which was confirmed by the validation cohort (C-index=0.787 (95% CI 0.722 to 0.853)). The calibration curve showed that the nomogram-based predictions were consistent with actual observation in both derivation cohort and validation cohort. CONCLUSION The proposed nomogram showed favourable predictive accuracy for minor stroke and TIA. This has the potential to contribute to clinical decision-making.
Collapse
Affiliation(s)
- Zhihao Lei
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shuanglin Li
- Department of Forensic Genetics, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Hongye Feng
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yupeng Lai
- Department of Rheumatology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yanxia Zhou
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chao Li
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| |
Collapse
|
9
|
Wang GF, Zhao X, Liu SP, Xiao YL, Lu ZN. Efficacy and Safety of Mechanical Thrombectomy for Acute Mild Ischemic Stroke with Large Vessel Occlusion. Med Sci Monit 2020; 26:e926110. [PMID: 32628645 PMCID: PMC7362709 DOI: 10.12659/msm.926110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background The suitability of mechanical thrombectomy (MT) for patients with acute mild ischemic stroke (AMIS) caused by large vessel occlusion (LVO) is controversial. This study evaluated MT in patients with AMIS and LVO. Material/Methods Forty-seven patients diagnosed as AMIS with LVO received MT or intravenous thrombolysis (IVT). Primary outcomes were National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale scores. Secondary outcomes were incidence of systemic complications and symptomatic intracranial hemorrhage. Results There were no significant differences between IVT and MT groups for gender, age, risk factors of cerebrovascular disease, past history, NIHSS score at admission, blood pressure, and LVO sites. For all patients, the NIHSS scores at discharge were lower than those at admission. Patients with excellent outcomes were 66.6% (16/24) in the IVT group and 60.8% (14/23) in the MT group; favorable outcome rates were 75% (18/24) in the IVT group and 69.6% (16/23) in the MT group, with no significant differences between groups. Twelve patients (52.2%) in the MT group and 5 (20.8%) in the IVT group had systemic complications. Symptomatic intracranial hemorrhage was not detected in the IVT group, but manifested in 2 (8.7%) patients in the MT group. During 90-day follow-up, 1 patient died in each of the IVT and MT groups, with 4.2% and 4.4% mortality rates, respectively. Conclusions The efficacy of MT and IVT was comparable in AMIS patients with LVO. While MT had a higher incidence of systemic complications, its short- and long-term effects were equivalent to IVT.
Collapse
Affiliation(s)
- Gui-Fang Wang
- Department of Neurology, Wuhan University, Renmin Hospital, Wuhan, Hubei, China (mainland).,Department of Neurology, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Xue Zhao
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Shu-Ping Liu
- Department of Neurology, Wuhan University, Renmin Hospital, Wuhan, Hubei, China (mainland)
| | - Yi-Lei Xiao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Zu-Neng Lu
- Department of Neurology, Wuhan University, Renmin Hospital, Wuhan, Hubei, China (mainland)
| |
Collapse
|
10
|
Mac Grory B, Nackenoff A, Poli S, Spitzer MS, Nedelmann M, Guillon B, Preterre C, Chen CS, Lee AW, Yaghi S, Stretz C, Azher I, Paddock J, Bakaeva T, Greer DM, Shulman JG, Kowalski RG, Lavin P, Mistry E, Espaillat K, Furie K, Kirshner H, Schrag M. Intravenous Fibrinolysis for Central Retinal Artery Occlusion: A Cohort Study and Updated Patient-Level Meta-Analysis. Stroke 2020; 51:2018-2025. [PMID: 32568646 DOI: 10.1161/strokeaha.119.028743] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Central retinal artery occlusion results in sudden, painless, usually permanent loss of vision in the affected eye. There is no proven, effective treatment to salvage visual acuity and a clear, unmet need for an effective therapy. In this work, we evaluated the efficacy of intravenous tissue-type plasminogen activator (IV alteplase) in a prospective cohort study and an updated systematic review and meta-analysis. METHODS We enrolled consecutive patients with acute central retinal artery occlusion within 48 hours of symptoms onset and with a visual acuity of <20/200 from January 2009 until May 2019. The primary outcomes were safety and functional visual acuity recovery. We compared rates of visual recovery between those treated with alteplase within 4.5 hours of symptom onset to those who did not receive alteplase (including an analysis restricted to untreated patients presenting within the window for treatment). We incorporated these results into an updated systematic review and patient-level meta-analysis. RESULTS We enrolled 112 patients, of whom 25 (22.3% of the cohort) were treated with IV alteplase. One patient had an asymptomatic intracerebral hemorrhage after IV alteplase treatment. Forty-four percent of alteplase-treated patients had recovery of visual acuity when treated within 4.5 hours versus 13.1% of those not treated with alteplase (P=0.003) and 11.6% of those presenting within 4 hours who did not receive alteplase (P=0.03). Our updated patient-level meta-analysis of 238 patients included 67 patients treated with alteplase within 4.5 hours since time last known well with a recovery rate of 37.3%. This favorably compares with a 17.7% recovery rate in those without treatment. In linear regression, earlier treatment correlated with a higher rate of visual recovery (P=0.01). CONCLUSIONS This study showed that the administration of intravenous alteplase within 4.5 hours of symptom onset is associated with a higher likelihood of a favorable visual outcome for acute central retinal artery occlusion. Our results strongly support proceeding to a randomized, placebo-controlled clinical trial.
Collapse
Affiliation(s)
- Brian Mac Grory
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Alex Nackenoff
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Sven Poli
- Department of Neurology with Focus on Neurovascular Diseases, and Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Germany (S.P.)
| | - Martin S Spitzer
- Eye Clinic, University Hospital Hamburg-Eppendorf, Germany (M.S.S.)
| | - Max Nedelmann
- Department of Neurology, Sana Regio Klinikum, Pinneberg, Germany (M.N.)
| | - Benoit Guillon
- Department of Neurology, CHU de Nantes - Laennec Nantes, France (B.G., C.P.)
| | - Cécile Preterre
- Department of Neurology, CHU de Nantes - Laennec Nantes, France (B.G., C.P.)
| | - Celia S Chen
- Department of Ophthalmology, Flinders Medical Center and Flinders University, Adelaide, Australia (C.S.C.)
| | - Andrew W Lee
- Department of Neurology, Flinders University and the Calvary Wakefield Hospital, Adelaide, Australia (A.W.L.)
| | - Shadi Yaghi
- Department of Neurology, New York University School of Medicine (S.Y.)
| | - Christoph Stretz
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Idrees Azher
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - John Paddock
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Tatiana Bakaeva
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI.,Division of Ophthalmology, Department of Surgery (T.B.), Warren Alpert Medical School of Brown University, Providence, RI.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (T.B.)
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, MA (D.M.G., J.G.S.)
| | - Julie G Shulman
- Department of Neurology, Boston University School of Medicine, MA (D.M.G., J.G.S.)
| | | | - Patrick Lavin
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN.,Department of Ophthalmology and Visual Sciences (P.L.), Vanderbilt University School of Medicine, Nashville, TN
| | - Eva Mistry
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Kiersten Espaillat
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Karen Furie
- Department of Neurology (B.M.G., C.S., I.A., J.P., T.B., K.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Howard Kirshner
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Matthew Schrag
- Department of Neurology (A.N., P.L., E.M., K.E., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
11
|
Akhtar N, Kamran S, Elkhider H, Al-Makki S, Mhjob N, ElShiekh L, AlHussain H, Ali M, Khodair R, Wadiwala F, Salam A, Deleu D, Francis R, Shuaib A. Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome. PLoS One 2020; 15:e0231448. [PMID: 32330144 PMCID: PMC7182193 DOI: 10.1371/journal.pone.0231448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background and purpose Patients with acute stroke and mild or rapidly improving symptoms frequently show progression. The role of reperfusion treatment in such patients is not clear. We hypothesized that progression was most likely in patients with cortical localization and such patients may benefit from thrombolysis. Material and methods We interrogated Hamad Stroke Database to evaluate 90-days outcome in patients with acute ischemic stroke admitted within 4 hours and a NIHSS score of ≤6. Evaluation was based on localization (lacunar or cortical), multi-model imaging abnormalities and whether they received rt-PA. The 90-day mRS was used to determine outcome. Results During study period 6381 patients were admitted with acute stroke. Mild stroke within 4 hours was diagnosed in 506 [no thrombolysis: 381(lacunar: 213; cortical: 168), thrombolysis: 125 (lacunar: 45; cortical: 80)]. The rt-PA treated patients had significantly higher NIHSS (2.94±3.9 versus 1.28±2.46, p<0.0001), increased rates of complications (16.0% versus 3.9%, p<0.0001) and longer hospital stay (6.05±8.1 versus 3.78±3.6 days; p<0.001). In patients with cortical stroke, intracranial arterial occlusions (11.6% vs 3.9%, p<0.0001) and CTP mismatch (22.2% vs 4.4%, p<0.0001) were more frequent in rt-PA treated patients. Discharge mRS (33.6% versus 13.9%, p<0.001) and 90-days mRS (23.2% versus 11.8%, p = 0.002) was significantly worse in patients with cortical stroke (rt-PA-treated and untreated patients). Conclusions The outcome in patients with mild stroke depends on lesion location (lacunar versus cortical) and severity of symptoms. Patients who receive rt-PA have significantly larger deficits, increased imaging abnormalities and higher rates of hospital complication, explaining the poor outcome in such subjects.
Collapse
Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Soha Al-Makki
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Noha Mhjob
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Lubna ElShiekh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hassan AlHussain
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Musab Ali
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rola Khodair
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal Wadiwala
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Salam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Stroke Program, University of Alberta, Edmonton, Canada
- * E-mail: ,
| |
Collapse
|
12
|
Nomura E, Takemaru M, Himeno T, Kono R, Fukushima T, Ota S. Clinical features and efficacy of reperfusion therapy in minor ischemic stroke patients with atrial fibrillation. J Thromb Thrombolysis 2020; 50:608-613. [PMID: 32048168 DOI: 10.1007/s11239-020-02057-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The efficacy of reperfusion therapy (RT) using intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy for minor ischemic stroke (MIS) has not yet been established. The present study aimed to elucidate the clinical features of MIS patients with atrial fibrillation (AF) and examine whether they could be potential candidates for RT. Data of MIS patients, defined as those with a score ≤ 5 on the National Institute of Health Stroke Scale, were extracted from patients admitted to our hospital between 2006 and 2018, and clinical characteristics were compared between the AF and non-AF groups. Thereafter, the impact of RT on outcomes in the AF- group was evaluated using the modified Rankin scale (mRS) score 3 months after onset and compared to that of standard medical therapy (SMT) using propensity score matching (PSM). Of 10,483 stroke patients, 3003 were shortlisted, and 457 AF patients and 2546 non-AF patients were finally selected. Patients in the AF group had more RT (13.3% vs. 5.7%, p < 0.001) than those in the non-AF group. Using PSM, 53 patients each were extracted from the AF-RT and AF-SMT groups. The frequencies of mRS = 0 or 1 for the AF-RT and AF-SMT groups were 69.8% and 64.2% (p = 0.536), respectively, with a significant difference in mRS = 0 (56.5% vs. 34.0%, p = 0.019). The present study found that MIS patients with AF underwent more RT than those without AF and that RT compared favorably with SMT for them; further study is warranted to examine whether these patients could be good candidates for RT.
Collapse
Affiliation(s)
- Eiichi Nomura
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan.
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Ryuhei Kono
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Tomoko Fukushima
- Department of Cerebrovascular Research, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Shinzo Ota
- Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| |
Collapse
|
13
|
Mac Grory B, Lavin P, Kirshner H, Schrag M. Thrombolytic Therapy for Acute Central Retinal Artery Occlusion. Stroke 2020; 51:687-695. [DOI: 10.1161/strokeaha.119.027478] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Brian Mac Grory
- From the Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (B.M.G.)
| | - Patrick Lavin
- Department of Ophthalmology and Visual Sciences (P.L.), Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology (P.L., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Howard Kirshner
- Department of Neurology (P.L., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| | - Matthew Schrag
- Department of Neurology (P.L., H.K., M.S.), Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
14
|
Lan L, Rong X, Li X, Zhang X, Pan J, Wang H, Shen Q, Peng Y. Reperfusion therapy for minor stroke: A systematic review and meta-analysis. Brain Behav 2019; 9:e01398. [PMID: 31532082 PMCID: PMC6790315 DOI: 10.1002/brb3.1398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Approximately, half of the acute stroke patients with minor symptoms were excluded from thrombolysis in some randomized controlled trials (RCTs). There is little evidence on treating minor strokes with rt-PA. Here, we performed a systematic review and meta-analysis to assess the safety and efficacy of thrombolysis in these patients. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched in July 2018. All available RCTs and retrospective comparative studies that compared thrombolysis with nonthrombolysis' for acute minor stroke (NIHSS ≤ 5) with quantitative outcomes were included. RESULTS Ten studies, including a total of 4,333 patients, were identified. The risk of intracranial hemorrhage (ICH) was higher in the rt-PA group as compared with that in the non-rt-PA group (3.8% vs. 0.6%; p = .0001). However, there is no significant difference in the rate of mortality between the two groups (p = .96). The pooled rate of a good outcome in 90 days was 67.8% in those with rt-PA and 63.3% in those without rt-PA (p = .07). Heterogeneity was 43% between the studies (p = .08). After adjusting for the heterogeneity, thrombolysis was associated with good outcome (68.3% vs. 63.0%, OR 1.47; 95% CI 1.14-1.89; p = .003). In post hoc analyses, including only RCTs, the pooled rate of good outcome had no significant differences between the two groups (86.6% vs. 85.7%, 95% CI 0.44-3.17, p = .74; 87.4% vs. 91.9%, 95% CI 0.35-1.41, p = .32; before and after adjusting separately). CONCLUSIONS Although thrombolysis might increase the risk of ICH based on existing studies, patients with acute minor ischemic stroke could still benefit from thrombolysis at 3 months from the onset.
Collapse
Affiliation(s)
- Lihuan Lan
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Xiaoming Rong
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Xiangpen Li
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Xiaoni Zhang
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Jingrui Pan
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Hongxuan Wang
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Qingyu Shen
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Ying Peng
- Department of NeurologySun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| |
Collapse
|
15
|
Schwartz JK, Capo-Lugo CE, Akinwuntan AE, Roberts P, Krishnan S, Belagaje SR, Kovic M, Burns SP, Hu X, Danzl M, Devos H, Page SJ. Classification of Mild Stroke: A Mapping Review. PM R 2019; 11:996-1003. [PMID: 30746896 DOI: 10.1002/pmrj.12142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/28/2019] [Indexed: 11/11/2022]
Abstract
Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.
Collapse
Affiliation(s)
- Jaclyn K Schwartz
- Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Carmen E Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | | | - Pamela Roberts
- Department of Physical Medicine and Rehabilitation and Department of Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, CA
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, School of Medicine, Atlanta, GA
| | - Samir R Belagaje
- Depts. of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mark Kovic
- Midwestern University, Downers Grove, IL
| | | | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Megan Danzl
- Doctor of Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, Louisville, KY
| | - Hannes Devos
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS
| | - Stephen J Page
- B.R.A.I.N. Laboratory (Better Rehabilitation and Assessment for Improved Neurorecovery); Division of Occupational Therapy, The Ohio State University, Columbus, OH
| |
Collapse
|
16
|
Schultheiss M, Härtig F, Spitzer MS, Feltgen N, Spitzer B, Hüsing J, Rupp A, Ziemann U, Bartz-Schmidt KU, Poli S. Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series. PLoS One 2018; 13:e0198114. [PMID: 29813111 PMCID: PMC5973600 DOI: 10.1371/journal.pone.0198114] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 05/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND No evidence-based therapy exists for non-arteritic central retinal artery occlusion (NA-CRAO). Retinal ischemic tolerance is low; irreversible damage occurs within four hours of experimental NA-CRAO. In previous randomized trials evaluating intra-arterial or intravenous thrombolysis (IVT) in NA-CRAO, only one patient was treated this early. In December 2013, the Departments of Neurology & Stroke and Ophthalmology at University Hospital Tuebingen, Germany, decided to treat patients using IVT within 4.5 hours of NA-CRAO, the therapeutic window established for ischemic stroke. MATERIALS AND METHODS Consecutive NA-CRAO patients with severe visual loss received IVT after exclusion of intracranial hemorrhage. Follow-up was conducted at day 5 (d5) and day 30 (d30). Visual outcomes were compared to the conservative standard treatment (CST) arm of the EAGLE-trial. RESULTS Until August 2016, 20 patients received IVT within 4.5 hours after NA-CRAO with a median onset-to-treatment time of 210 minutes (IQR 120-240). Visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.46±0.33 (SD) (light perception) to 1.52±1.09 (Snellen equivalent: 6/200) at d5 (p = 0.002) and 1.60±1.08 (Snellen equivalent: 6/240) at d30. Compared to the EAGLE CST-arm, functional recovery to reading ability occurred more frequently after IVT: 6/20 (30%) versus 1/39 (3%) at d5 (p = 0.005) and at d30 5/20 (25%) versus 2/37 (5%) (p = 0.045). Two patients experienced serious adverse events (one angioedema and one bleeding from an abdominal aortic aneurysm) but recovered without sequelae. CONCLUSIONS IVT within 4.5 hours after symptom onset may represent an effective treatment of NA-CRAO. Randomized trials are warranted to evaluate efficacy and safety of early IVT in acute NA-CRAO.
Collapse
Affiliation(s)
- Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Eye Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Florian Härtig
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany
| | - Martin S. Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Eye Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Bernhard Spitzer
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Johannes Hüsing
- Coordination Center for Clinical Trials, University Hospital Heidelberg, Heidelberg, Germany
| | - André Rupp
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany
| | | | - Sven Poli
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
17
|
Bhogal P, Andersson T, Maus V, Mpotsaris A, Yeo L. Mechanical Thrombectomy-A Brief Review of a Revolutionary new Treatment for Thromboembolic Stroke. Clin Neuroradiol 2018; 28:313-326. [PMID: 29744519 DOI: 10.1007/s00062-018-0692-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/17/2018] [Indexed: 01/19/2023]
Abstract
The recent success of endovascular stroke treatment has heralded a new era in the management of acute ischemic stroke (AIS) with significantly improved outcome for patients. A large number of patients may be amenable to this new treatment and as the evidence expands the number of patients eligible for mechanical thrombectomy continues to increase. Recent evidence suggests that the time window for treatment can be extended up to 24 h after symptom onset for patients with anterior circulation strokes; however, many clinicians and medical professionals may not be aware of these recent changes and it is important that they are kept up-to-date with this rapidly evolving treatment. This review provides an overview of the recent successful trials and highlights important steps that should be instituted in order to achieve rapid reperfusion and optimize the outcome for ischemic stroke patients. It also looks at the remaining controversies facing the field of thrombectomy. A short summary of each of these contentious areas is provided and the current state of the art.
Collapse
Affiliation(s)
- Pervinder Bhogal
- St. Bartholomew's and the Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
| | - Tommy Andersson
- Departments of Neuroradiology and Clinical Neuroscience, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Volker Maus
- Department of Neuroradiology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | | | - Leonard Yeo
- Departments of Neuroradiology and Clinical Neuroscience, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.,Department of Medicine (Neurology), National University Health system and Yong Loo Lin school of medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
18
|
Zhang MWB, Lim RBC, Lee C, Ho RCM. Prevalence of Internet Addiction in Medical Students: a Meta-analysis. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:88-93. [PMID: 28849574 DOI: 10.1007/s40596-017-0794-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE With the development of online learning, communication, and entertainment, the Internet has become an indispensable tool for university students. Internet addiction (IA) has emerged as a health problem and the prevalence of IA varies from country to country. To date, the global prevalence of IA in medical students remains unknown. The objective of this meta-analysis was to establish precise estimates of the prevalence of IA among medical students in different countries. METHODS The pooled prevalence of IA among medical students was determined by the random-effects model. Meta-regression and subgroup analysis were performed to identify potential factors that could contribute to heterogeneity. RESULTS The pooled prevalence of IA among 3651 medical students is 30.1% (95% confidence interval (CI) 28.5-31.8%, Z = -20.66, df = 9, τ 2 = 0.90) with significant heterogeneity (I 2 = 98.12). Subgroup analysis shows the pooled prevalence of IA diagnosed by the Chen's Internet Addiction Scale (CIAS) (5.2, 95% CI 3.4-8.0%) is significantly lower than Young's Internet Addiction Test (YIAT) (32.2, 95% CI 20.9-45.9%) (p < 0.0001). Meta-regression analyses show that the mean age of medical students, gender proportion and the severity of IA are not significant moderators. CONCLUSIONS In conclusion, this meta-analysis identified the pooled prevalence of IA among medical students is approximately five times than that of the general population. Age, gender, and severity of IA did not account for high heterogeneity in prevalence, but IA assessment questionnaire was a potential source of heterogeneity. Given the high prevalence of IA, medical teachers and medical school administrators should identify medical students who suffer from IA and refer them for intervention.
Collapse
Affiliation(s)
- Melvyn W B Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore.
- National University of Singapore, Singapore, Singapore.
| | - Russell B C Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Roger C M Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
19
|
You S, Saxena A, Wang X, Tan W, Han Q, Cao Y, Liu CF. Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis. Stroke Vasc Neurol 2018; 3:22-27. [PMID: 29600004 PMCID: PMC5870640 DOI: 10.1136/svn-2017-000106] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022] Open
Abstract
The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0–1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I2=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I2=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I2=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.
Collapse
Affiliation(s)
- Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Anubhav Saxena
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - WeeYong Tan
- Department of Neurology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Qiao Han
- Department of Neurology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institutes of Neuroscience, Soochow University, Suzhou, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institutes of Neuroscience, Soochow University, Suzhou, China
| |
Collapse
|
20
|
Kim YR, Hwang IC, Lee YJ, Ham EB, Park DK, Kim S. Stroke risk among patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Clinics (Sao Paulo) 2018; 73:e177. [PMID: 29723340 PMCID: PMC5910631 DOI: 10.6061/clinics/2018/e177] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022] Open
Abstract
Increased stroke risk among chronic obstructive pulmonary disease patients has not yet been established. In this study, we conducted a systematic review and meta-analysis to assess stroke risk among chronic obstructive pulmonary disease patients. PubMed, EMBASE, and the Cochrane Library were systematically searched from database inception until December 31, 2016 to identify longitudinal observational studies that investigated the association between chronic obstructive pulmonary disease and stroke. Stroke risk was quantified by overall and subgroup analyses, and a pooled hazard ratio was calculated. Study quality was evaluated using the Newcastle-Ottawa Scale. Publication bias was assessed using Begg's rank correlation test. Eight studies met the inclusion criteria. In a random-effects model, significantly increased stroke risk was observed among chronic obstructive pulmonary disease patients (hazard ratio, 1.30; 95% confidence interval, 1.18-1.43). In subgroup analyses stratified by stroke subtype, study quality, and adjustment by socioeconomic status, the association between increased stroke risk and chronic obstructive pulmonary disease patients was robust. Statistically significant publication bias was not detected. In summary, chronic obstructive pulmonary disease was found to be associated with increased stroke risk. Additional prospective studies are required to elucidate the mechanisms underlying the increase in stroke risk and identify effective preventive interventions.
Collapse
Affiliation(s)
- Yu Ree Kim
- Department Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - In Cheol Hwang
- Department Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
- *Corresponding author. E-mail:
| | - Yong Joo Lee
- Department of Family Medicine, Catholic University Seoul St. Mary’s Hospital, Seoul, Republic of Korea
- #These authors contributed equally to this work
| | - Eun Bee Ham
- Department Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Dong Kyun Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sewan Kim
- Shingil Yonsei Clinic, Seoul, Republic of Korea
| |
Collapse
|
21
|
Dong W, Xian Y, Yuan W, Huifeng Z, Tao W, Zhiqiang L, Shan F, Ya F, Hongli W, Jinghuan W, Lei Q, Li Z, Hongyi Q. Catalpol stimulates VEGF production via the JAK2/STAT3 pathway to improve angiogenesis in rats' stroke model. JOURNAL OF ETHNOPHARMACOLOGY 2016; 191:169-179. [PMID: 27301615 DOI: 10.1016/j.jep.2016.06.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/05/2016] [Accepted: 06/08/2016] [Indexed: 05/25/2023]
Abstract
ETHNOBOTANICAL RELEVANCE Catalpol is the main active component of the radix from Rehmannia glutinosa Libosch, which has pleiotropic protective effects in neurodegenerative diseases, ischemic stroke, metabolic disorders and others AIM Catalpol has been shown to have neuroprotective, neurorepair, and angiogenesis effects following ischemic brain injury. However, its molecular mechanisms are still poorly understood. In previous studies, the JAK2/STAT3 signaling pathway was found to play a role in neuroprotection and angiogenesis. This study investigated the role of catalpol in stimulating angiogenesis via the JAK2/STAT3 pathway after permanent focal cerebral ischemia (pMCAO). METHODS Rats were subjected to right middle cerebral artery occlusion through electrocoagulation and were treated with catalpol (5mg/kg), AG490 was also used to inhibit STAT3 phosphorylation (pSTAT3). RESULTS Following stroke, Catalpol improved the neuroethology deficit, increased the cerebral blood flow (CBF) of infarcted brain and upregulated EPO and EPOR. AG490 suppressed the phosphorylation of signal transducer and activator of transcription 3 (STAT3), ultimately inhibited VEGF mRNA expression, which reduced VEGF protein expression and inhibited stroke-induced angiogenesis. However, Catalpol enhanced stroke-induced STAT3 activation and subsequently restored STAT3 activity through the recovery of STAT3 binding to VEGF. Moreover, Catalpol reversed the effect of AG490 on STAT3 activation and nuclear translocation, restored the transcriptional activity of the VEGF promoter by recruiting STAT3 to the VEGF promoter, improved VEGF mRNA and protein expression, increased angiogenesis, reduced the difference in CBF between the infarcted and intact brain and ameliorated the neuroethology behaviors after stroke. CONCLUSION Catalpol affects neuroprotection and angiogenesis via the JAK2/STAT3 signaling pathway, which is mediated by STAT3 activation and VEGF expression. Catalpol may be used as a potential therapeutic drug for stroke.
Collapse
MESH Headings
- Angiogenesis Inducing Agents/pharmacology
- Animals
- Brain/drug effects
- Brain/enzymology
- Brain/pathology
- Brain/physiopathology
- Cerebral Arteries/drug effects
- Cerebral Arteries/enzymology
- Cerebral Arteries/pathology
- Cerebral Arteries/physiopathology
- Cerebrovascular Circulation/drug effects
- Disease Models, Animal
- Erythropoietin/metabolism
- Infarction, Middle Cerebral Artery/drug therapy
- Infarction, Middle Cerebral Artery/enzymology
- Infarction, Middle Cerebral Artery/pathology
- Infarction, Middle Cerebral Artery/physiopathology
- Iridoid Glucosides/pharmacology
- Janus Kinase 2/metabolism
- Male
- Neovascularization, Physiologic/drug effects
- Neuroprotective Agents/pharmacology
- Phosphorylation
- Promoter Regions, Genetic
- Protein Binding
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats, Sprague-Dawley
- Receptors, Erythropoietin/metabolism
- STAT3 Transcription Factor/metabolism
- Signal Transduction/drug effects
- Time Factors
- Transcriptional Activation
- Up-Regulation
- Vascular Endothelial Growth Factor A/genetics
- Vascular Endothelial Growth Factor A/metabolism
Collapse
Affiliation(s)
- Wan Dong
- Department of Emergency, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yang Xian
- Department of Pharmacy, The Seventh People's Hospital of Chengdu, Chengdu 610041, China
| | - Wang Yuan
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Zhu Huifeng
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China.
| | - Wang Tao
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Liu Zhiqiang
- Department of Pharmacy, The First People's Hospital of Neijiang, Neijiang 641000, China
| | - Feng Shan
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Fu Ya
- College of Chemistry and Chemical Engineering, Chongqing University of Science & Technology, Chongqing 401331, China
| | - Wang Hongli
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Wang Jinghuan
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Qin Lei
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Zou Li
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| | - Qi Hongyi
- College of Pharmaceutical Sciences and Traditional Chinese Medicine, Southwest University, Chongqing 400715, China; Chongqing Engineering Research Center for Pharmacological Evaluation, Chongqing 400715, China; Engineering Research Center for Chongqing Pharmaceutical Process and Quality Control, Chongqing 400715, China
| |
Collapse
|
22
|
Yang J, Yu F, Liu H, An H, Xiong R, Huang D. A Retrospective Study of thrombolysis with 0.6 mg/kg Recombinant Tissue Plasminogen Activator (rt-PA) in Mild Stroke. Sci Rep 2016; 6:31344. [PMID: 27510959 PMCID: PMC4980662 DOI: 10.1038/srep31344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/18/2016] [Indexed: 11/09/2022] Open
Abstract
We sought to assess the safety, effectiveness and cost of 0.6 mg/kg rt-PA treatment for patients with acute mild stroke and to compare that with 0.9 mg/kg. We retrospectively analyzed consecutive acute ischemic stroke patients who had a NIHSS score ≤5 at admission and who were treated with rt-PA within 4.5 hours of symptom onset. The demographic data, clinical outcomes and hospitalization cost were analyzed. A total of 108 patients were included. Forty six patients (42.6%) received a 0.6 mg/kg dosage of rt-PA. The baseline characteristics of the two groups were well matched (p > 0.05). Regarding the safety and effectiveness, the 0.6 mg/kg dosage group had a comparable proportion of symptomatic intracranial hemorrhage (sICH) (0.6 mg/kg, 4.3% vs 0.9 mg/kg, 4.8%; p > 0.05), early neurological deterioration (END) (19.6% vs 17.7%; p > 0.05), in-hospital mortality (4.3% vs 1.6%; p > 0.05), and a similar rate of favorable functional outcome (mRS score 0–1) at 3 months (73.9% vs 71.0%; p > 0.05) to those who received the standard dosage. However, the hospital cost was markedly lower in the 0.6 mg/kg group (0.6 mg/kg, 3,401.7 USD vs 0.9 mg/kg, 4,157.4 USD; p < 0.01). Our study suggest that 0.6 mg/kg rt-PA shared similar effectiveness and safety profile compared with that of 0.9 mg/kg in treating mild stroke, but cost less.
Collapse
Affiliation(s)
- Jie Yang
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Fei Yu
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hong Liu
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hedi An
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Ran Xiong
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Dongya Huang
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| |
Collapse
|
23
|
Bhatt A, Lesko A, Lucas L, Kansara A, Baraban E. Patients with Low National Institutes of Health Stroke Scale Scores Have Longer Door-to-Needle Times: Analysis of a Telestroke Network. J Stroke Cerebrovasc Dis 2016; 25:2253-8. [PMID: 27266620 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/30/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The benefits of intravenous tissue-type plasminogen activator (IV-tPA) in acute ischemic stroke (AIS) are time dependent. Because emergency rooms quickly initiate a stroke alert with more severe symptoms, we hypothesized that patients with lower National Institutes of Health Stroke Scale (NIHSS) scores, indicating a less severe stroke, would have longer door-to-needle (DTN) times compared to patients with higher NIHSS scores. METHODS Data obtained from the 19-hospital Providence Stroke Registry were used to identify AIS patients who received IV-tPA within 4.5 hours of last-known-well. NIHSS scores were obtained prior to tPA administration at the time of emergency department presentation and categorized as low-NIHSS (score = 0-5) or high-NIHSS (score = 6-42) strokes. Median DTN times were collected for both groups as the primary outcome variable. Linear mixed-effects regression models were used to assess the effect of NIHSS scores on DTN and its 2 components: door-to-CT (DCT) and CT-to-needle (CTN) times. RESULTS We identified 692 AIS patients who received IV-tPA within 4.5 hours of last-known-well, with 198 patients presenting with low-NIHSS strokes and 494 patients with high-NIHSS strokes. In multivariable analysis, median DTN time was estimated to be 18% higher for low-NIHSS strokes than high-NIHSS strokes after adjusting for covariates (P < .001). Median DCT times were also higher for low-NIHSS (19 minutes) compared to high-NIHSS (11 minutes) strokes after adjusting for covariates (P < .001), whereas CTN times were unchanged (P = .055). CONCLUSION In AIS patients receiving IV-tPA in a telestroke network, lower NIHSS scores were associated with longer DTN and DCT times.
Collapse
Affiliation(s)
- Archit Bhatt
- Providence Brain and Spine Institute, Portland, Oregon.
| | | | - Lindsay Lucas
- Providence Brain and Spine Institute, Portland, Oregon
| | - Amit Kansara
- Providence Brain and Spine Institute, Portland, Oregon
| | | |
Collapse
|
24
|
van den Wijngaard IR, Algra A, Lycklama à Nijeholt GJ, Boiten J, Wermer MJ, van Walderveen MA. Value of Whole Brain Computed Tomography Perfusion for Predicting Outcome after TIA or Minor Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2081-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/25/2015] [Accepted: 05/06/2015] [Indexed: 11/17/2022] Open
|
25
|
Marchidann A, Balucani C, Levine SR. Expansion of Intravenous Tissue Plasminogen Activator Eligibility Beyond National Institute of Neurological Disorders and Stroke and European Cooperative Acute Stroke Study III Criteria. Neurol Clin 2015; 33:381-400. [DOI: 10.1016/j.ncl.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
26
|
Yeo LLL, Rathakrishnan R, Paliwal PR, Sharma VK. Should minor strokes be excluded from intravenous thrombolysis? Neurol Sci 2014; 36:1255-6. [DOI: 10.1007/s10072-014-1957-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
|