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Cappellari M, Pracucci G, Saia V, Fainardi E, Casetta I, Sallustio F, Ruggiero M, Longoni M, Simonetti L, Zini A, Lazzarotti GA, Giannini N, Da Ros V, Diomedi M, Vallone S, Bigliardi G, Limbucci N, Nencini P, Ajello D, Marcheselli S, Burdi N, Boero G, Bracco S, Tassi R, Boghi A, Naldi A, Biraschi F, Nicolini E, Castellan L, Del Sette M, Allegretti L, Sugo A, Buonomo O, Dell'Aera C, Saletti A, De Vito A, Lafe E, Mazzacane F, Bergui M, Cerrato P, Feraco P, Piffer S, Augelli R, Vit F, Gasparotti R, Magoni M, Comelli S, Melis M, Menozzi R, Scoditti U, Cavasin N, Critelli A, Causin F, Baracchini C, Guzzardi G, Tarletti R, Filauri P, Orlandi B, Giorgianni A, Cariddi LP, Piano M, Motto C, Gallesio I, Sepe FN, Romano G, Grasso MF, Pauciulo A, Rizzo A, Comai A, Franchini E, Sicurella L, Galvano G, Mannino M, Mangiafico S, Toni D, On Behalf Of The Iretas Group. IV thrombolysis plus thrombectomy versus IV thrombolysis alone for minor stroke with anterior circulation large vessel occlusion from the IRETAS and Italian SITS-ISTR cohorts. Neurol Sci 2023; 44:4401-4410. [PMID: 37458843 DOI: 10.1007/s10072-023-06948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/04/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The aim of this study was to compare the outcomes of patients treated with intravenous thrombolysis (IVT) <4.5 h after symptom onset plus mechanical thrombectomy (MT) <6 h with those treated with IVT alone <4.5 h for minor stroke (NIHSS ≤5) with large vessel occlusion (LVO) in the anterior circulation. PATIENTS AND METHODS Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analyzed. RESULTS Among the patients with complete data on 24-h ICH type, 236 received IVT plus MT and 382 received IVT alone. IVT plus MT was significantly associated with unfavorable shift on 24-h ICH types (from no ICH to PH-2) (OR, 2.130; 95% CI, 1.173-3.868; p=0.013) and higher rate of PH (OR, 4.363; 95% CI, 1.579-12.055; p=0.005), sICH per ECASS II definition (OR, 5.527; 95% CI, 1.378-22.167; p=0.016), and sICH per NINDS definition (OR, 3.805; 95% CI, 1.310-11.046; p=0.014). Among the patients with complete data on 3-month mRS score, 226 received IVT plus MT and 262 received IVT alone. No significant difference was reported between IVT plus MT and IVT alone on mRS score 0-1 (72.1% versus 69.1%), mRS score 0-2 (79.6% versus 79%), and death (6.2% versus 6.1%). CONCLUSIONS Compared with IVT alone, IVT plus MT was associated with unfavorable shift on 24-h ICH types and higher rate of 24-h PH and sICH in patients with minor stroke and LVO in the anterior circulation. However, no difference was reported between the groups on 3-month functional outcome measures.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Valentina Saia
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Enrico Fainardi
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Fabrizio Sallustio
- Unitá di Trattamento Neurovascolare, Ospedale dei Castelli-ASL6, Rome, Italy
| | - Maria Ruggiero
- Neuroradiologia, AUSL Romagna Ospedale Bufalini, Cesena, Italy
| | - Marco Longoni
- Neurologia e Stroke Unit Ospedale Bufalini Cesena, AUSL Romagna, Ravenna, Italy
| | - Luigi Simonetti
- UO Neuroradiologia Ospedale Maggiore-IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | - Nicola Giannini
- Neurological Institute, University Hospital of Pisa, Pisa, Italy
| | - Valerio Da Ros
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Nicola Limbucci
- Neurovascular Interventional Unit-Careggi University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit, Azienda Ospedaliero Univarsitaria Careggi, Firenze, Italy
| | - Daniele Ajello
- Neuroradiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Nicola Burdi
- Neuroradiology, SS. Annunziata Hospital, Taranto, Italy
| | | | - Sandra Bracco
- Neuroradiologia interventistica, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Andrea Boghi
- SC Radiologia e Neuroradiologia, Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- S.C. Neurologia 2 Ospedale San Giovanni Bosco, Torino, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Universita degli Studi di Roma Sapienza, Rome, Lazio, Italy
| | - Ettore Nicolini
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lucio Castellan
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Massimo Del Sette
- Neurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Allegretti
- Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy
| | - Annalisa Sugo
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Orazio Buonomo
- Neuroradiology Unit, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences-University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine-University of Messina, Messina, Italy
| | - Andrea Saletti
- Servizio di Neuroradiologia, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Neurology Division-Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Elvis Lafe
- UOC Radiologia Diagnostica per Immagini 2-Neuroradiologia, Policlinico IRCCS San Matteo, Pavia, Italy
| | - Federico Mazzacane
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Mauro Bergui
- Università Torino Dipartimento Neuroscienze, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paola Feraco
- U.O.C. Neuroradiologia diagnostica e Radiologia Interventistica, Ospedale Santa Chiara, Trento, Italy
| | - Silvio Piffer
- U.O.C Neurologia, Ospedale Santa Chiara, APSS di Trento, Trento, Italy
| | - Raffaele Augelli
- Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Federica Vit
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neuroscience Department, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Nicola Cavasin
- Neuroradiology Unit, Ospedale dell'Angelo, USSL 3 Serenissima, Mestre, Venice, Italy
| | - Adriana Critelli
- Neurology Unit, Ospedale dell'Angelo, USSL 3 Serenissima, Mestre, Venice, Italy
| | - Francesco Causin
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | | | | | - Pietro Filauri
- UOSD Radiologia interventistica, p.o., Avezzano, AQ, Italy
| | | | - Andrea Giorgianni
- UOC Neuroradiologia, ASST Sette Laghi Varese-Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Mariangela Piano
- Interventional Neuroradiology Unit, Ospedale Niguarda, Milan, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit AO "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | | | | | | | | | - Annalisa Rizzo
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Alessio Comai
- Neuroradiologia, Ospedale Provinciale di Bolzano, Bolzano, Italy
| | | | | | | | | | - Salvatore Mangiafico
- IRCCS Neuromed, Pozzilli, IS, Italy
- Tor Vergata University, Rome, Italy
- Sapienza University, Rome, Italy
- S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Tu WJ, Xu Y, Liu Y, Li J, Du J, Zhao J. Intravenous Thrombolysis or Medical Management for Minor Strokes. Thromb Haemost 2023. [PMID: 37037201 DOI: 10.1055/s-0043-1768150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To evaluate the outcomes of acute ischemic stroke patients with minor deficits treated with either intravenous thrombolysis (IVT) or routine medical management (MM). METHODS The study included patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores of 5 or less who were treated with IVT within 4.5 hours from symptom onset and were classified as the IVT group. The MM group consisted of an equal number of patients with minor strokes, matched for sex, age, and severity, who did not receive thrombolysis. Data on patient information were collected for both groups. RESULTS A total of 26,236 patients were included in this study (13,208 in IVT and 13,208 in MM). Of these patients, 67.9% were men, and the mean age was 67.1 years (standard deviation: 10.9). At 3 months, the IVT group had a higher rate of stroke-independent outcome (Rankin Scale score of 0-2) compared with the MM group (IVT vs. MM: 91.6 vs. 88.6%, absolute difference: 2.5%, 95% confidence interval [CI]: 1.6-3.4%, p = 0.008; adjusted hazard ratio [HR]: 1.2, 95% CI: 1.1-1.4, p = 0.003). Furthermore, there was no significant difference in 3-month mortality rates between the IVT and MM groups (IVT vs. MM: 2.1 vs. 2.5%, absolute difference: -0.6%, 95% CI: -1.1 to 0.3%, p = 0.11; adjusted HR: 0.9, 95% CI: 0.8-1.2, p = 0.09). CONCLUSION Compared with MM, IVT does not reduce mortality in minor ischemic stroke but improves functional outcomes in minor stroke with an NIHSS score of 3 to 5.
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Affiliation(s)
- Wen-Jun Tu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, People's Republic of China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Yakun Liu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Jilai Li
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Jichen Du
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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