Thrombolytic therapy for acute ischemic stroke following intracranial artery dissection: Fukuoka stroke registry

2017 ◽  
Vol 381 ◽  
pp. 394-395 ◽  
Author(s):  
S. Arakawa ◽  
Y. Furuta ◽  
M. Osaki ◽  
S. Sakai ◽  
S. Kimura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Artery Dissection ◽  
Intracranial Artery ◽  
Stroke Registry ◽  
Intracranial Artery Dissection

Abstract TP219: Hyperintense Vessels on FLAIR MRI Suggest Dissection and Large-Artery Atherosclerosis but Do Not Predict Outcome in Acute Posterior Circulation Infarct

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Maki Takahashi ◽  
Takeo Sato ◽  
Takahiro Maku ◽  
Haruhiko Motegi ◽  
Hiroki Takatsu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Posterior Circulation ◽  
Unfavorable Outcome ◽  
Artery Dissection ◽  
Large Artery ◽  
Intracranial Artery ◽  
Stroke Patients ◽  
Intracranial Artery Dissection ◽  
Posterior Circulation Infarct

Background and Purpose: Hyperintense vessel sign on FLAIR (HVS) has been described in hyperacute stroke patients with arterial occlusion. It’s a surrogate marker for stroke severity in patients with acute ischemic stroke of the anterior circulation. We aimed to reveal the clinical significance of HVS in patients with acute posterior circulation infarction. Methods: This observational study is based on a single-center prospective registry study. Inclusion criteria were: symptomatic ischemic stroke patients who have lesions only in posterior circulation; and taken initial MRI within 14 days from onset.An unfavorable outcome was defined as mRS score of 2 to 6 at 3 months from the onset. First investigation is to estimate whether HVS could be related to the subtype of acute ischemic stroke (cohort A). Second, the correlation between HVS and mRS at 3 months was evaluated (cohort B). Results: From October 2012 to May 2019, consecutive 1,079 ischemic stroke subjects were screened, including 277 in cohort A (191 male, median age 64 years) and 240 in cohort B (165 male, median age 66 years, Figure A). In cohort A, HVS was independently associated with intracranial artery dissection (OR 5.228; 95% CI 2.270-12.039; p = 0.001) and large-artery atherosclerosis (OR 3.582; 95% CI 1.244-10.317; p = 0.018, Figure B). In cohort B, HVS was not a factor independently associated with unfavorable outcome (OR 2.925; 95% CI 0.881-9.714; p = 0.080). Conclusions: HVS in patients with posterior circulation infarct suggests intracranial artery dissection or large-artery atherosclerosis, but does not have impact on their clinical courses.

Abstract 2: Thrombolytic Therapy and Survival for Medicare Beneficiaries with Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Quanhe Yang ◽  
Mary G George
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Matched Pair ◽  
Medicare Beneficiaries ◽  
Term Survival ◽  
Early Reperfusion ◽  
Stroke Registry ◽  
Probability Of Survival ◽  
Neurologic Outcomes

Background: Thrombolytic therapy (tPA) is the only fibrinolytic agent used in the treatment of acute ischemic stroke. It is recommended due to its ability to achieve early reperfusion and improve neurologic outcomes. This study assesses the survival outcome of tPA use among Medicare beneficiaries with acute ischemic stroke in the Paul Coverdell National Acute Stroke Registry (PCNASR). Methods: A total of 24,625 patients with a clinical diagnosis of acute ischemic stroke enrolled in the PCNASR from January 2008-December 2010 were linked to MEDPAR 2008-2010 database. Patients with documented reasons for not giving tPA (intravenous and/or intra-arterial) were excluded. A propensity score 1:1 matched-pair sample was created to assess survival among patients receiving tPA and not receiving tPA. The probability of survival was estimated by the Kaplan-Meier method and was compared by the test described by Klein and Moeschberger. The hazard ratio was obtained by using Cox proportional hazard regression model stratified on matched pairs. Results: A total of 3370 matched patients were selected based on age, gender, race, National Institutes of Health Stroke Scale (NIHSS), medical history of atrial fibrillation, diabetes, heart failure, smoking, prior stroke and myocardial infarction or coronary disease. Patients who received tPA had better survival than patients with no tPA (p=0.0109). The adjusted hazard ratios were 0.84, [0.72, 0.98], 0.86 [0.75, 0.99] and 0.84 [0.74, 0.96] for 30-days, 90-days and one-year survival, respectively. Limitation: In the absence of direct identifiers, the linked datasets might contain possible incorrect information. Conclusion: This analysis found approximately 15% improved short and long term survival among patients receiving tPA for acute ischemic stroke in a non-clinical trial setting.

scholarly journals EXPRESS: ESO guideline for the management of extracranial and intracranial artery dissection

2021 ◽  
pp. 239698732110464
Author(s):  
Stephanie Debette ◽  
Michael mazighi ◽  
Philippe Bijlenga ◽  
Alessandro Pezzini ◽  
Masatoshi Koga ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Phase ◽  
Observational Studies ◽  
Expert Consensus ◽  
Artery Dissection ◽  
Intracranial Artery ◽  
Consensus Statements ◽  
Intracranial Artery Dissection

The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-based recommendations on the management of extracranial artery dissection (EAD) and intracranial artery dissection (IAD). EAD and IAD represent leading causes of stroke in the young, but are uncommon in the general population, thus making it challenging to conduct clinical trials and large observational studies. The guidelines were prepared following the Standard Operational Procedure for European Stroke Organisation guidelines and according to GRADE methodology. Our four recommendations result from a thorough analysis of the literature comprising two randomized clinical trials (RCTs) comparing anticoagulants to anti-platelets in the acute phase of ischemic stroke and twenty-six comparative observational studies. In EAD patients with acute ischemic stroke we recommend using intravenous thrombolysis (IVT) with alteplase within 4.5 hours of onset if standard inclusion/exclusion criteria are met, and mechanical thrombectomy in patients with large vessel occlusion of the anterior circulation. We further recommend early endovascular or surgical intervention for IAD patients with subarachnoid hemorrhage (SAH). Based on evidence from two phase 2 RCTs that have shown no difference between the benefits and risks of anticoagulants versus anti-platelets in the acute phase of symptomatic EAD, we strongly recommend that clinicians can prescribe either option. In post-acute EAD patients with residual stenosis or dissecting aneurysms and in symptomatic IAD patients with an intracranial dissecting aneurysm and isolated headache, there is insufficient data to provide a recommendation on the benefits and risks of endovascular/surgical treatment. Finally, nine expert consensus statements, adopted by 8 to 11 of the 11 experts involved, propose guidance for clinicians when the quality of evidence was too low to provide recommendations. Some of these pertain to the management of IAD (use of IVT, endovascular treatment, and antiplatelets versus anticoagulation in IAD with ischemic stroke and use of endovascular or surgical interventions for IAD with headache only). Other expert consensus statements address the use of direct anticoagulants and dual antiplatelet therapy in EAD-related cerebral ischemia, endovascular treatment of the EAD/IAD lesion and multidisciplinary assessment of the best therapeutic approaches in specific situations.

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