Abstract P401: Subocclusive and Occlusive Intracranial Thrombi in Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lacy S Handshoe ◽  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Course ◽  
Neurological Deterioration ◽  
High Rate ◽  
Control Group ◽  
Nihss Score ◽  
Good Outcome ◽  
Ct Angiogram ◽  
Group Sex

Background: Non-occlusive thrombus in an intracranial artery in acute ischemic stroke is an uncommon occurrence. We compared the clinical course and outcome of intracranial subocclusive to occlusive thrombi. Methods: We conducted a review of patients who presented with acute ischemic stroke and received CT angiogram at a single comprehensive stroke center from January 2018 to December 2019. Patients with intracranial subocclusive thrombus were compared to a control group with complete occlusion matched for occlusion location. Subocclusive thrombus was reviewed by two raters on CT angiography, disagreement resolved by consensus. Patient and stroke characteristics and the clinical course were analyzed. Neurological deterioration was defined as an increase in NIH Stroke Scale (NIHSS) score > 4 compared from baseline to 48 hours. Good outcome at discharge was defined as modified Rankin Score of ≤2. Results: Among 1151 acute ischemic strokes, there were 896 patients with CT angiograms. Sixteen out of 896 (1.8%) patients had intracranial subocclusive thrombus. Thirty-two with comparable intracranial occlusions were identified. In the subocclusive group, 3 of 16 (19%) of received acute endovascular intervention, compared to 13 of 32 (41%) in the occluded group. Sex, median age or time from last known well to hospital arrival did not differ between the two groups. The subocclusive thrombus group had less severe strokes, with median NIHSS score at arrival 3 compared to 8.5 in the occlusion group (p<0.01) and median NIHSS at discharge 1 compared to 5.5 in the occlusive group (p<0.01). Frequency of neurological deterioration in hospital did not differ between the subocclusive and occluded groups at 48 hours (15% vs 15% p=1.00). The subocclusive group was associated with a good outcome at discharge, OR 0.5.71, 95% confidence interval 1.41-23.1. Conclusion: Intracranial subocclusive thrombus in acute ischemic stroke has a more mild presentation compared to complete intracranial occlusion without a high rate of neurological deterioration.

Abstract WP22: Reperfusion Therapy After Neurological Deterioration in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mooseok Park ◽  
Tai Hwan Park ◽  
Sang-Soon Park ◽  
Jong-Moo Park ◽  
Yong-Jin Cho ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Features ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Reperfusion Therapy ◽  
Neurological Deterioration ◽  
Large Artery ◽  
Good Outcome ◽  
Intravenous Tissue Plasminogen Activator

Background: Guidelines do not recommend reperfusion therapy in acute ischemic stroke patients with mild symptoms considering low gain compared to the risk. However, some patients with mild first symptoms experience neurological deterioration (ND) after hospitalization. We aimed to analyze clinical features and outcomes of patient who received reperfusion therapy after ND occurred. Methods: We enrolled patients who were admitted within 7 days after acute ischemic stroke or TIA between January 2012 and July 2018 from a multicenter stroke registry database in Korea (CRCS-K). Patients who 1) admitted via emergency room, and 2) received reperfusion therapy including intravenous tissue plasminogen activator and/or endovascular treatment were included. Clinical features and outcomes such as modified Rankin Scale (mRS) score distribution at 3 months after stroke were compared between patients received reperfusion therapy after ND and those without ND before the treatment. Results: Among 51325 patients, 6577 (12.8%) received reperfusion therapy were identified. Reperfusion therapy was performed after ND in 136 patients (2.1%). Mean time of onset to needle is 342.1 and 167.2, and onset to perfusion is 1351.6 and 422.0 in patients treated after ND, and those without, respectively. TIA history was more frequent and atrial fibrillation history was less frequent in patients treated after ND. Initial median (IQR) National Institute of Health Stroke Scale (NIHSS) score was 8 (5 - 12), 10 (6 - 16) in patients treated after ND, and those without, respectively. Large artery atherosclerosis was more frequent in patients treated after ND (42.9 % vs. 26.7%). There was higher rate of good outcome at 90 days in patients treated after ND (84 [61.8%]) compared with those without ND before treatment (3359 [52.2%]; OR, 1.38 [95% CI, 1.02-1.87]). In multivariable analysis, good outcome at 90 days in patients treated after ND lacked statistical significance (OR, 1.06 [95% CI, 0.71-1.62]). There is no significant statistical difference of death at 90 days (13.2% vs. 10.4%, p = 0.364). Conclusion: Reperfusion therapy could apply patients with mild first symptoms experience ND after hospitalization and expect similar prognosis compared to those without ND before the treatment.

Abstract TP8: Safety And Outcome After Endovascular Reperfusion Therapy In Elderly Patients With Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Kevin N Sheth ◽  
John B Terry ◽  
Raul G Nogueira ◽  
Anat Horev ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Neural Plasticity ◽  
Reperfusion Therapy ◽  
P Value ◽  
Nihss Score ◽  
Good Outcome ◽  
Initial Severity ◽  
Baseline Factors

Background: Age is a strong predictor of outcomes following acute ischemic stroke (AIS). Conflicting data exist on whether endovascular reperfusion therapy (ERT) should be offered to patients over 80 years of age. We compared the safety and efficacy of ERT in elderly (> 80 years) compared to non-elderly (< 80 years) patients with AIS. Methods: We collected data from a large multi-center prospective registry of AIS patients treated with ERT. Data were available on demographics, initial severity, angiographic results, hemorrhagic complications using the ECASS criteria, and 3-month functional outcomes using the modified Rankin Scale (mRS). The thrombolysis in myocardial infarction (TIMI) score was used to grade reperfusion. We compared baseline factors, procedural results, and clinical outcomes in those over > 80 years versus those < 80 years. P-value < 0.05 was considered significant. Results: Among 1077 patients with anterior circulation AIS, 223 (20.7%) were > 80 years. Elderly patients were more likely to have atrial fibrillation (54.3% vs. 31.4%, P < 0.001) but less likely to have diabetes (16.1% vs. 24.6%; P=0.046) or smoking (13.2% vs. 32.6%, P<0.001) history. Both groups were similar in other baseline factors, initial NIHSS score, location of occlusions, time from onset to groin puncture. TIMI 2 or 3 reperfusion was achieved in 64.5% of those > 80 vs. 70.7% in those < 80 (P=0.080). Rates of symptomatic hemorrhage and any intracranial hemorrhage were not different between groups. Good outcome at 3 months (mRS 0-2) was noted in 16.5% of elderly compared to 41.5% of non-elderly patients (P<0.001). Amongst elderly patients, the only independent predictor of good outcome was initial NIHSS score (adj. OR 0.882, 95% CI 0.821-0.948); good outcomes were achieved in 32.1% of those with NIHSS score < 10, 16.8% with NIHSS score 11-20, and only 5.9% with NIHSS score > 20. Conclusions: Patients > 80 years account for over one-fifth of those treated with ERT in this large registry and had worse outcomes compared with those < 80 years despite similar initial severity, time to treatment, and procedural results. Other factors such as increased baseline disability, more rapid time to completed infarction, and reduced neural plasticity may be contributing to these findings.

Endovascular treatment in acute ischemic stroke: collaboration between neurologists and cardiologists in a single center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Petrov ◽  
M Klissurski ◽  
Z Stankov ◽  
I Tasheva ◽  
P Polomski
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Carotid Stenting ◽  
Clinical Results ◽  
High Rate ◽  
Single Center ◽  
Nihss Score ◽  
Endovascular Methods ◽  
Favorable Clinical Outcome

Abstract Background Several randomized trials have indicated a benefit from endovascular therapy in acute ischemic stroke (AIS) patients. In some centers, interventional cardiologists with previous large carotid stenting experience can play significant role for this treatment. Objectives We present retrospective analysis of prospectively collected data of endovascular treatment of stroke (EVTS) performed by interventional cardiologists in collaboration with neurologists in 46 patients in single center. Methods Between 2014 and 2017 46 consecutive AIS patients underwent EVT, men 69.7% (7 with posterior circulation stroke and 5 with wake-up stroke), with mean age 64.6±13 years and average National Institutes of Health Stroke Scale (NIHSS) score of 12.2±5 at presentation. During the same period of time 20 patients, 16 men, at mean age 69.4±12, and NIHSS score 11.8±7 received IVT. In the EVT group two methods were applied: Method 1, Supraselective intra-arterial thrombolysis (IAT) alone or IAT plus balloon angioplasty (PBA); Method 2, Aspiration with Penumbra aspiration system (PAS) or Combination of PAS plus low dose IAT. Results The mean symptoms onset-to-treatment (needle) time (ONT) in the EVT group was 221.7±121.5 minutes, and 185.5±34.9 in the IVT group (p=0.19T). Conscious sedation and local anesthesia was used in 84.7% of the patients (40), general anesthesia in 15.2%; preprocedural MRI was performed in 58.7% and CT in 71.7% of the patients. In the EVT group successful reperfusion (TICI 2b-3 flow) was achieved in 35 (76.1%) patients: in 73.9% with Method 1 and in 86.7% with Method 2 (p=0.44). Poor or no recanalization (TICI 0–1-2a) was observed in 26.1%. Twenty six of 46 patients (56.5%) treated with endovascular methods and respectively 9 (45%) with IVT demonstrated favorable clinical outcome of mRS score 0–2 at 90 days (p=0.91). The overall 3-month mortality was 15.2%, 13% after EVT and 20% after IVT (p=0.48). Conclusions Our initial experience with EVT of AIS performed by trained cardiologists with carotid experience is encouraging, with a relatively moderate to high rate of successful angiographic recanalization and good clinical results. Funding Acknowledgement Type of funding source: None

scholarly journals Lower Intraprocedural Systolic Blood Pressure Predicts Good Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

2015 ◽  
Vol 4 (3-4) ◽  
pp. 151-157 ◽  
Author(s):  
Seby John ◽  
Walaa Hazaa ◽  
Ken Uchino ◽  
Gabor Toth ◽  
Mark Bain ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Hemodynamic Variable ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Nihss Score ◽  
Good Outcome

Background: It is unknown if intraprocedural blood pressure (BP) influences clinical outcomes and what BP parameter best predicts outcomes in acute ischemic stroke (AIS) patients who undergo intra-arterial therapy (IAT) for emergent large vessel occlusion. Methods: We retrospectively reviewed 147 patients who underwent IAT for anterior circulation AIS from January 2008 to December 2012 at our institution. Baseline demographics, stroke treatment variables, and detailed intraprocedural hemodynamic variables were collected. Results: The entire cohort consisted of 81 (55%) females with a mean age of 66.9 ± 15.6 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 16 (IQR 11-21). Thirty-six (24.5%) patients died during hospitalization, 25 (17%) achieved a 30-day modified Rankin Scale score of 0-2, and 24 (16.3%) suffered symptomatic parenchymal hematoma type 1/2 hemorrhage. Patients who achieved a good outcome had a significantly lower admission NIHSS score, a higher baseline CT ASPECTS score, and a lower rate of ICA terminus occlusions. Successful recanalization was more frequent in the good-outcome group, while symptomatic hemorrhages occurred only in poor-outcome patients. The first systolic BP (SBP; 146.5 ± 0.2 vs. 157.7 ± 25.6 mm Hg, p = 0.042), first mean arterial pressure (MAP; 98.1 ± 20.8 vs. 109.7 ± 20.3 mm Hg, p = 0.024), maximum SBP (164.6 ± 27.6 vs. 180.9 ± 18.3 mm Hg, p = 0.0003), and maximum MAP (125.5 ± 18.6 vs. 138.5 ± 24.6 mm Hg, p = 0.0309) were all significantly lower in patients who achieved good outcomes. A lower maximum intraprocedural SBP was an independent predictor of good outcome (adjusted OR 0.929, 95% CI 0.886-0.963, p = 0.0005). Initial NIHSS score was the only other independent predictor of a good outcome. Conclusion: Lower intraprocedural SBP was associated with good outcome in patients undergoing IAT for AIS, and maximum SBP was an independent predictor of good outcome. SBP may be the optimal hemodynamic variable to monitor intraprocedurally during IAT and may predict outcome.

scholarly journals Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eung-Joon Lee ◽  
Jeonghoon Bae ◽  
Hae-Bong Jeong ◽  
Eun Ji Lee ◽  
Han-Yeong Jeong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Elevated Serum ◽  
Unfavorable Outcome ◽  
Control Group ◽  
Nihss Score ◽  
And Control ◽  
D Dimer

Abstract Background The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT. Methods We retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT. Results A total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively). Conclusions MT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.

Abstract 127: Predictors of Good Functional Outcomes in an Acute Ischemic Stroke Cohort with a Large Infarct Core Treated with Mechanical Thrombectomy: Signals to Treat?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jeffrey Wagner ◽  
Donald Frei ◽  
Raul Nogueira ◽  
Adnan Siddiqui ◽  
Osama O Zaidat ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Target Vessel ◽  
Infarct Core ◽  
Nihss Score ◽  
Good Outcome ◽  
Large Infarct

Purpose: Mechanical thrombectomy has been demonstrated to provide benefits in the treatment of acute ischemic stroke (AIS). But whether to treat AIS patients with a large infarct core remains controversial. Although it is a common practice that patients with large infarct core are not offered endovascular treatment, previous data have consistently shown a proportion of these patients may benefit from IA intervention. The purpose of this study is to identify predictors of good outcomes in an AIS cohort with a large infarct volume previously treated with mechanical thrombectomy. Hypothesis: We hypothesize that among AIS patients with a large infarct volume, younger patients (≤66 years) who present with lower NIHSS scores will show good functional outcomes (mRS 0-2) at 90 days if treated with mechanical thrombectomy. Methods: Univariable and multivariable analyses were preformed to identify factors that predict good functional outcomes in AIS patients with ASPECTS 0-5 who were treated with the Penumbra System. Five previous prospective, multicenter trials (PIVOTAL, PICS, RetroSTART, START, SEPARATOR 3D) were included in this study. Patients who presented with symptoms of AIS were analyzed for association between presenting demographics and modified Rankin scale (mRS) score at 90 days in univariate and multivariate analyses. Results: Data for 614 patients with a median age of 69 years and an NIHSS score of 18 met study criteria. Of these, the 90-day mRS 0-2 rate and mortality were, respectively, 40.23% and 25.41%. Among those with ASPECTS 0-5 (N=93), 17.20% had good functional outcome. An age of ≤66 years was significantly associated with good outcome (p<0.0001) among those with ASPECTS 0-5. Within this age group who had ASPECTS 0-5, a baseline NIHSS score of ≤ 20 (p= 0.0088) with a target vessel location at the MCA (p=0.0210) were also strong predictors of good outcome if treated by mechanical thrombectomy. Conclusion: These data demonstrate that age ≤66 years, baseline NIHSS score of ≤ 20 with a target vessel location in the MCA are important predictors of good outcomes in an AIS cohort with a large infarct core who are eligible for mechanical thrombectomy.

EFFICIENT TREATMENT OF ACUTE ISCHEMIC STROKE WHITHIN 4.5 HOURS WITH INTRAVENOUS ALTEPLASE IN VINH PHUC GENERAL HOSPITAL

2017 ◽  
pp. 55-59
Author(s):  
Hong Trung Le ◽  
Van Huy Nguyen ◽  
Van Chi Nguyen ◽  
Duy Ton Mai
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Manifestations ◽  
Hemorrhagic Transformation ◽  
Patient Admission ◽  
Control Group ◽  
Efficient Treatment ◽  
Nihss Score ◽  
Intravenous Alteplase ◽  
Mean Time

Objectives: To evaluate the efficient treatment of acute ischemic stroke within 4.5 hours with intravenous Alteplase. Method: To describe the intervention both prospectively and retrospectively, no control group. Results: mean age 68.9 ± 12.06; mean time of treatment 169.4 ± 43.78; at the patient admission, mean NIHSS 14.5 ± 12.06; 1 hour after treatment, NIHSS score decrease ≥ 4 in 43.5% patients; 24 hours after treatment, NIHSS score decrease ≥ 4 in 56.6% patients; 83.9% of patients had revascularization after treatment; 10.7% of patients had hemorrhagic transformation but only 4% of patients had clinical manifestations. NIHSS above 14 score, embolism site, were risk factors for outcome. Conclusions: treatment of acute ischemic stroke whithin 4.5 hours with intravenous Alteplase is safe and effective. Key words: acute ischemic stroke, intravenous Alteplase

scholarly journals Association of H-Type Hypertension with Stroke Severity and Prognosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Tan Li ◽  
Jiajia Zhu ◽  
Qi Fang ◽  
Xiaoyu Duan ◽  
Mingzhi Zhang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Independent Risk Factor ◽  
Cox Regression ◽  
Stroke Recurrence ◽  
Control Group ◽  
Stroke Severity ◽  
Multiple Factor Analysis ◽  
Nihss Score

Background. The correlation between H-type hypertension and acute ischemic stroke remains uncertain. Objective. The present study was designed to explore the possible relationship between H-type hypertension and severity and prognosis of acute ischemic stroke. Method. We included 372 patients with acute ischemic stroke and divided them into four groups: H-type hypertension group, simple hypertension group, simple hyperhomocysteinemia (HHcy) group, and the control group. NIHSS score was measured at both admission and two weeks later. mRS score, stroke recurrence, cardiovascular event, or all-cause mortality was recorded at 3-month and 1-year follow-up. Result. The results showed that the NIHSS score on admission in the H-type hypertension group (6.32 ± 5.91) was significantly higher than that in the control group (3.97 ± 3.59) (P < 0.05), while there was no obvious association between H-type hypertension and NIHSS score after 2-week treatment (P = 0.106). Endpoint events incidence in H-type hypertension group was the highest; however, in the cox regression model of multiple factor analysis, H-type hypertension was not an independent risk factor. Conclusion. H-type hypertension may result in early functional deterioration and higher incidence rate of endpoint events but not act as an independent risk factor.

scholarly journals The golden 35 min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome

2017 ◽  
Vol 10 (3) ◽  
pp. 213-220 ◽  
Author(s):  
Ali Alawieh ◽  
Alyssa K Pierce ◽  
Jan Vargas ◽  
Aquilla S Turk ◽  
Raymond D Turner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Good Outcome ◽  
First Pass ◽  
Procedural Time

IntroductionIn acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60 min has previously been associated with an increased complication rate and poorer outcomes.ObjectiveAfter improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomy approach: a direct aspiration first pass technique (ADAPT).MethodsWe retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups: ‘early recan’, in which recanalization (recan) was achieved in ≤35 min, and ‘late recan’, in which procedures extended beyond 35 min.Results197 patients (47.7% women, mean age 66.3 years) were identified. We determined that after 35 min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0–2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between ‘early recan’ (n=122) (14.7±6.9) and ‘late recan’ patients (n=75) (15.9±7.2). Among ‘early recan’ patients, recanalization was achieved in 17.8±8.8 min compared with 70±39.8 min in ‘late recan’ patients. The likelihood of achieving a good outcome was higher in the ‘early recan’ group (65.2%) than in the ‘late recan’ group (38.2%; p<0.001). Patients in the ‘late recan’ group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the ‘early recan’ group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes.ConclusionsOur findings suggest that extending ADAPT thrombectomy procedure times beyond 35 min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome.

scholarly journals Advanced Age and Higher National Institutes of Health Stroke Scale Score as Predictors of Poor Outcome in Ischemic Stroke Patients Treated with Alteplase: A Study from a Tertiary Care Centre in Rural North-west India

2017 ◽  
Vol 08 (02) ◽  
pp. 236-240 ◽  
Author(s):  
Amit Bhardwaj ◽  
Girish Sharma ◽  
Sunil Kumar Raina ◽  
Ashish Sharma ◽  
Monica Angra
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Tertiary Care ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Nihss Score ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor

ABSTRACT Introduction: Thrombolytic therapy in acute ischemic stroke has been approved for treatment of acute stroke for past two decades. However, identification of predictors of poor outcome after the intravenous (IV) alteplase therapy in acute stroke patients is a matter of research. The present study was conducted with the aim of identifying poor prognostic factors in patients of acute ischemic stroke patients. Methods: The data of 31 acute stroke patients treated with alteplase were gathered to identify the factors that were independent predictors of the poor outcome. Outcome was dichotomized using modified Rankin scale (mRS) score and National Institutes of Health Stroke Scale (NIHSS) score at 3 months after treatment into good outcome mRS - 0–2 and poor outcome mRS - 3–6. Predictors of poor outcome were analyzed. Results: Good outcome (mRS – score 0–2) was seen in 15 (48.4%) patients with median age of (60) and poor outcome (mRS – score 3–6) was seen in 16 (51.6%) patients median age of 75 years, which was statistically significant with the P = 0.002. The presence of risk factors such as hypertension, diabetes, dyslipidemia, smoking, alcohol intake, history of stroke, coronary artery disease, and rheumatic heart disease among the two groups did not seem influence outcome. The severity of stroke as assessed by NIHSS score at the time of presentation was significantly higher among the patients with poor outcome, with P = 0.01. Conclusion: Advance age and higher NIHSS score at the time of onset of stroke and are the independent predictors of the poor outcome after thrombolysis with IV alteplase treatment in acute ischemic stroke patients.

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