Nonatrial Fibrillation was Associated With Early Neurological Improvement After Intravenous Thrombolysis With rt-PA in Patients With Acute Ischemic Stroke

Background and Purpose: Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. Methods: All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. Results: We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. Conclusions: Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.

Download Full-text

Abstract TP25: Early Major Neurologic Improvement after Endovascular Therapy in Acute Ischemic Stroke

Stroke ◽

10.1161/str.44.suppl_1.atp25 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Luzma Cardona ◽

Dolora Wisco ◽

Shu-Mei Man ◽

Pravin George ◽

Esteban Cheng-Ching ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Favorable Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

Neurological Improvement ◽

Arterial Recanalization ◽

Pre Treatment

Background and Purpose: Intravenous thrombolysis is associated with early major neurologic improvement, which is reported to occur in about a quarter of patients after 24 hrs. The aim of the study is to evaluate the frequency and predictors of early major improvement in patient with ischemic stroke after undergoing acute intra-arterial therapy. Materials and methods: Prospective collected database of patients undergoing intra-arterial therapy for the acute ischemic stroke from January 2008 to December 2011 was reviewed. The NIHSS was used to assess severity of stroke in patients upon admission, 24 hrs after procedure and at hospital discharge. Major neurological improvement was defined as improvement of NIHSS by more or equal to 8 or absolute NIHSS of 0 or 1. Arterial recanalization was defined as thrombolysis in cerebral infarction grade 2b or 3. Favorable outcome was defined as modified Rankin scale of 0-2 at 1 month and 3 months. Demographic and radiographic data were collected. Results: MNI was seen in 28 out of 138 (20%) of patients at 24 hours but was not associated with a 30 day or 90 day favorable outcome. MNI at discharge was seen in 47 of 148 (31%) patients and was associated with a 30 day and 90 day favorable outcomes of 0-2 on mRankin (Odds Ratio (OR) : 9.1, 95% confidence interval (CI): 3.7-22.5). Recanalization was associated with MNI at 24 hours (OR 3.1, 95% CI: 1.2-7.9) and MNI at discharge (OR 2.8, 95% CI: 1.3-6.0). Among pre-treatment variables, MNI at discharge was associated with imaging by pre-treatment Alberta Stroke Program Early CT Score (median 9 with MNI, 8 without MNI, p=0.03) and time to treatment (median 5.2 hours with MNI v 7.2 hours without MNI, p<0.01). Age and baseline NIHSS were not associated with MNI. In a logistic regression model, favorable outcome at 90 days was independently associated with baseline NIHSS and MNI at discharge. Conclusions: MNI after intra-arterial therapy was seen in about a quarter of patients and was associated with higher CT ASPECT scores, time to therapy, and arterial recanalization. MNI at discharge was an independent predictor of long term outcome.

Download Full-text

Predictors of major neurological improvement after intravenous thrombolysis in acute ischemic stroke: A hospital-based study from south India

Neurology India ◽

10.4103/0028-3886.66085 ◽

2010 ◽

Vol 58 (3) ◽

pp. 403 ◽

Cited By ~ 12

Author(s):

Subhash Kaul ◽

DemuduBabu Boddu ◽

V.C.S Srinivasarao Bandaru ◽

PrasadG Reddy ◽

M Madhusudan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

South India ◽

Intravenous Thrombolysis ◽

Neurological Improvement

Download Full-text

Non-atrial fibrillation was associated with early neurological improvement after intravenous thrombolysis with rt-PA in patients with acute ischemic stroke

10.21203/rs.2.405/v1 ◽

2019 ◽

Author(s):

Jie Liu ◽

Jiaqi Huang ◽

Huimin Xu ◽

Haibin Dai

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

Independent Predictor ◽

Multivariable Analysis ◽

Laboratory Data ◽

Intravenous Thrombolysis ◽

Nihss Score ◽

Neurological Improvement

Abstract Background To investigate the factors associated with early neurological improvement of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to acute ischemic stroke (AIS) within 4.5 hours of onset. Methods Demographics onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at the Second Affiliated Hospital, Zhejiang University School of Medicine between January 2013 and August 2016 were retrospectively analyzed. The National Institute of Health Stroke Scale (NIHSS) score was recorded before thrombolytic therapy, 24 h after the treatment and 7 d after the treatment to evaluate the recovery of neurological function. A multivariate logistic regression analysis was performed to assess the outcomes. Results Of the 209 AIS patients treated by intravenous thrombolysis with rt-PA. Low-density lipoprotein (LDL) levels were significantly lower (P < 0.05) in patients with early neurological improvement. The multivariable analysis showed that non-atrial fibrillation (AF) was independently associated with early neurological improvement at 24 h and 7 d after thrombolysis. Onset to treatment time was an independent predictor (P < 0.05) for early neurological improvement at 7 d after thrombolysis. The NIHSS score and diastolic blood pressure on admission were associated with symptomatic intracerebral hemorrhagic (sICH) transformation. Conclusions Non-AF was independently associated with early neurological improvement after intravenous thrombolysis in AIS patients, but non-AF was not associated with the occurrence of sICH. Onset to treatment time was an independent predictor of early neurological improvement at 7 d after thrombolysis in AIS patients.

Download Full-text

Efficacy and Safety of Intravenous Thrombolysis in Patients with Acute Ischemic Stroke and Pre–Existing Disability

Journal of Clinical Medicine ◽

10.3390/jcm8030400 ◽

2019 ◽

Vol 8 (3) ◽

pp. 400 ◽

Cited By ~ 4

Author(s):

Giovanni Merlino ◽

Elisa Corazza ◽

Simone Lorenzut ◽

Gian Gigli ◽

Daniela Cargnelutti ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Intravenous Thrombolysis ◽

Severe Disability ◽

Favorable Outcome ◽

University Hospital ◽

Efficacy And Safety ◽

Neurological Improvement ◽

Disabled Patients

Little is known about intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with pre-existing disability. Disabled patients are often excluded from IVT treatment. Previous studies investigated the role of pre-existing disability on outcomes in AIS patients after IVT. However, no studies have been conducted to date to determine whether IVT may improve clinical outcomes in AIS patients with pre-existing disability. The aim of our study was to evaluate efficacy and safety of IVT in patients with pre-existing moderate and moderately severe disability (pre-stroke modified Rankin Scale score = 3 or 4) affected by AIS. This study was based on a retrospective analysis of a prospectively collected database of consecutive patients admitted to the Udine University Hospital with AIS from January 2015 to May 2018. The efficacy endpoints were the rate of favorable outcome and rate of major neurological improvement. The safety endpoints were the rate of mortality at three months, presence of intracranial hemorrhage (ICH), and presence of symptomatic intracranial hemorrhage (sICH). The study population included 110 AIS patients with pre-existing moderate and moderately severe disability, 36 of which received (IVT+) and 74 did not receive IVT (IVT−). AIS disabled patients treated with IVT had higher rates of favorable outcome (66.7% vs. 36.5%, p = 0.003) and major neurological improvement (39.4% vs. 17.4%, p = 0.01) compared to non-treated ones. Two in three disabled patients returned to their pre-stroke functional status when treated with IVT. Prevalence of three-month mortality, ICH, and sICH did not differ in the two groups. Disabled patients affected by AIS significantly improved after IVT. Moderate and moderately severe disability alone should not be considered, per se, as a contraindication to IVT treatment.

Download Full-text