Outcomes of intra-arterial thrombolytic treatment in acute ischemic stroke patients with a matched defect on diffusion and perfusion MR images

Early treatment of ischemic stroke with thrombolytics is associated with improved outcomes, but few stroke patients receive thrombolytic treatment in part due to the 3-hour time window. Advances in neuroimaging may help to aid in the selection of patients who may still benefit from thrombolytic treatment beyond conventional time-based guidelines. In this article the authors review the available literature in support of using advanced neuroimaging to select patients for treatment beyond the 3-hour time window cutoff and explore potential applications and limitations of perfusion imaging in the treatment of acute ischemic stroke.

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Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽

10.1161/str.43.suppl_1.a196 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Wondwossen G Tekle ◽

Saqib A Chaudhry ◽

Habib Qaiser ◽

Ameer E Hassan ◽

Gustavo J Rodriguez ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

The United States ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Referral Patterns ◽

Hospital Outcomes ◽

Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

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Thrombolytic Treatment Using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and Impact on Regional Thrombolytic Utilization and Referral Patterns (S03.002)

Neurology ◽

10.1212/wnl.78.1_meetingabstracts.s03.002 ◽

2012 ◽

Vol 78 (Meeting Abstracts 1) ◽

pp. S03.002-S03.002

Author(s):

G. Rodriguez ◽

W. Tekle ◽

S. Chaudhry ◽

A. Hassan ◽

M. Suri ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

The United States ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Referral Patterns ◽

Treatment Paradigm

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The Impact of Body Mass Index on the Thrombolytic Treatment of Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000446005 ◽

2016 ◽

Vol 42 (3-4) ◽

pp. 240-246 ◽

Cited By ~ 4

Author(s):

Anastasios Chatzikonstantinou ◽

Anne D. Ebert ◽

Marc E. Wolf

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Volume ◽

Body Mass ◽

Intravenous Thrombolysis ◽

Normal Weight ◽

Thrombolytic Treatment ◽

Stroke Patients

Background: Body weight and body mass index (BMI) are regularly assessed factors in stroke patients for manifold reasons. However, their potential role specifically in intravenous thrombolysis has not been thoroughly examined. Methods: Data from 865 consecutive acute ischemic stroke patients treated with intravenous thrombolysis were analyzed. Patients were divided into different BMI categories (underweight, normal weight, overweight, obese) and compared based on the following factors: time window of treatment, clinical scores National Institute of Health Stroke Scale Score (NIHSS), modified Rankin scale (mRS) on admission and discharge, risk factors, stroke characteristics and thrombolysis complications. Recombinant tissue plasminogen activator (rtPA) doses relative to body weight and blood volume were also assessed. In a separate analysis, patients weighing up to 100 and >100 kg were compared. Results: Eighteen patients (2.1%) were underweight, 336 (38.8%) overweight, 194 (22.4%) obese and 317 (36.7%) had normal weight. Higher BMI category was associated with younger age, thrombolytic treatment later than 4.5 h, arterial hypertension, diabetes and higher relative rtPA dose relative to blood volume (p < 0.001). There were no significant differences concerning NIHSS and mRS scores or thrombolysis complications. Forty-six patients (5.3%) weighed over 100 kg. They were younger (p = 0.002) and treated later than patients under 100 kg (p < 0.001). Mean rtPA dose relative to body weight and to blood volume was significantly lower (0.7 vs. 0.9 mg/kg, p < 0.001 and 13 vs. 13.9 mg/l, p < 0.001). There was a marginal difference in NIHSS score improvement ≥4 points (26.1 vs. 40.2%, p = 0.038); otherwise, no outcome differences were found. Conclusion: BMI category does not significantly influence clinical outcome after thrombolysis. However, relevant NIHSS improvement was found more often in patients weighing up to 100 kg compared to those over 100 kg. Interestingly, patients with higher BMI or weight >100 kg were thrombolysed later than other patients.

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Drip-and-Ship Thrombolytic Treatment Paradigm Among Acute Ischemic Stroke Patients in the United States

Stroke ◽

10.1161/strokeaha.112.657817 ◽

2012 ◽

Vol 43 (7) ◽

pp. 1971-1974 ◽

Cited By ~ 40

Author(s):

Wondwossen G. Tekle ◽

Saqib A. Chaudhry ◽

Ameer E. Hassan ◽

Gustavo J. Rodriguez ◽

M. Fareed K. Suri ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

The United States ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Treatment Paradigm

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Relationship between Pulsatility Index and Clinical Course of Acute Ischemic Stroke after Thrombolytic Treatment

BioMed Research International ◽

10.1155/2013/265171 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Nevzat Uzuner ◽

Özcan Özdemir ◽

Gülnur Tekgöl Uzuner

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Recombinant Tissue Plasminogen Activator ◽

Good Prognosis ◽

Acute Ischemia ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Nihss Score ◽

Arterial Recanalization ◽

Positive Correlations

Background. The relationship between the arterial recanalization after intravenous recombinant tissue plasminogen activator (rtPA) and outcomes is still uncertain. The aim of our study was to evaluate whether there is an association between the pulsatility indexes (PI) of the middle cerebral artery (MCA) measured by transcranial Doppler (TCD) after iv rtPA treatment and short- and long-term outcomes in ischemic stroke patients.Methods. Forty-eight patients with acute ischemia in the MCA territory who achieved complete recanalization after the administration of intravenous thrombolytic treatment were included in the study. The TCD was applied to patients after the iv rtPA treatment. Clinical and functional outcomes were assessed by National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scores (mRS), respectively.Results. Significant positive correlations were found between the PI value and NIHSS score at 24 hours, NIHSS score at 3 months, and mRS at 3 months ( for all). The cut-off value for PI in predicting a favorable prognosis and a good prognosis might be less than or equal to 1.1 and less than or equal to 1.4, respectively.Conclusions. PI may play a role in predicting the functional and clinical outcome after thrombolytic therapy in acute ischemic stroke patients.

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Abstract T P323: National Trends in Utilization and Outcomes of Intravenous Thrombolytic Treatment Among Pediatric Patients With Acute Ischemic Stroke in United States

Stroke ◽

10.1161/str.45.suppl_1.tp323 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Saqib A Chaudhry ◽

Taqi T Zafar ◽

Mohammad Afzal ◽

Malik M Adil ◽

Gautam Sachdeva? ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Pediatric Patients ◽

Fold Increase ◽

Adverse Outcomes ◽

P Value ◽

Thrombolytic Treatment ◽

Stroke Patients

Background: Thrombolytic treatment has been used with varying frequency among pediatric ischemic stroke patients. Objective: To evaluate trends in utilization of IV recombinant tissue plasminogen activator (rt-PA) and associated rates of death and disability among acute ischemic stroke patients over a six year period. Methods: We obtained data for pediatric patients (aged ≤18 years) admitted to United States in 2003, 2006 and 2009 with a primary diagnosis of ischemic stroke using the Nationwide Inpatient Sample (NIS-KID). We determined the rate and pattern of utilization, and associated in-hospital outcomes of IV-rt-PA including post-thrombolytic intracerebral hemorrhage (ICH) and rates death among pediatric ischemic stroke patients. Results: Of the 5,137 pediatric patients admitted with ischemic stroke, 48 (0.93%) received IV rt-PA during the study period. There was a 2.5 fold increase in rates of patients who received the thrombolytic treatment (0.53% in 2003, 0.87% in 2006 and 1.35% in 2009). The rate of post-thrombolytic ICH was 9.6% with no change in frequency over the three periods. The overall rate of post-thrombolytic intracerebral hemorrhage (ICH) was 9.6% with a trend towards decrease in rates (41%, 9.8%, and 0%) in 2003, 2006, and 2009. The overall rate of in hospital mortality was 9.6% with some decrease in rates (17.2%, 13.0%, and 5.9%, p value for trend=0.7). Conclusion: There has been a significant increase in the proportion of pediatric acute ischemic stroke patients receiving IV rt-PA treatment with some evidence of decrease in adverse outcomes at discharge.

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Abstract WP284: National Trends in Utilization and Outcomes of Thrombolytic Use by Drip and Ship Paradigm in Acute Ischemic Stroke Patients in United States

Stroke ◽

10.1161/str.51.suppl_1.wp284 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Saqib A Chaudhry ◽

Mohammad Rauf A Chaudhry ◽

Mohsain Gill ◽

Iqra N Akhtar ◽

Adnan I Qureshi

Keyword(s):

United States ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

The United States ◽

Severe Disability ◽

Multivariate Logistic Regression Model ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Hospital Outcomes

Background and Purpose: The drip and ship paradigm has rapidly expanded in the last decade allowing higher thrombolytic utilization and endovascular treatment. We performed this analysis to evaluate trends in utilization of drip and ship paradigm in United States and associated outcomes. Methods: We analyzed data for patients admitted with primary diagnosis of ischemic stroke in the United States from Nationwide Inpatient Sample, the largest nationally representative data, for the years 2009 to 2015. We studied changes in utilization of drip-and-ship paradigm and subsequent performance of endovascular treatment, and rates of discharge with none to minimal disability and moderate to severe disability. Results: Of the 3,043,190 patients admitted with ischemic stroke, 56,449 (1.85%) patients received thrombolytic treatment through drip-and-ship paradigm over a 7 year period. Of all patients who received thrombolytic treatment (n=243,824), 56,449 (23.15%) received using drip and ship paradigm. There was almost 3 fold increase in drip and ship paradigm (in 0.98% 2009 to 2.80% in 2015 (test for trend= p < 0.001). Among the patients who underwent drip and ship paradigm, 5,061 (8.97%) underwent endovascular treatment. The rate of endovascular treatment increased from 6.62% to 12.39% among patients treated with drip and ship paradigm (test for trend= p < 0.001). The rate of none minimal disability at discharge increased from 39.93% to 47.08%, (test for trend p < 0.001) while moderate to severe disability decreased 51.22% to 47.08%, (test for trend p < 0.001) in ischemic stroke patients treated using drip-and-ship paradigm. Similar trends were observed for hospital outcomes in multivariate logistic regression model, adjusted for age, gender, medical comorbidities and secondary intracranial hemorrhages. Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients treated using drip-and-ship paradigm (out of proportion to overall thrombolytic use) with increase in subsequent endovascular treatment in United States. The in hospital outcomes of patients have improved perhaps due to higher utilization of endovascular treatment.

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