The impact of intravenous thrombolysis on outcome of patients with acute ischemic stroke after 90 years old

Introduction: Given the recent positive endovascular therapy trials for acute ischemic stroke (AIS), this therapeutic strategy is now being increasingly incorporated into routine clinical practice. Identifying prognostic factors among AIS patients receiving endovascular revascularization treatments (ERT) in the real world could be important for clinicians and patients. While the impact of diabetes mellitus (DM) on IV thrombolytic outcomes after AIS has been extensively investigated, there is a paucity of data assessing effects of DM on ERT outcomes after AIS. We evaluated the impact of comorbid DM on ERT for AIS. Methods: From Jan 2011 to Feb 2016, patients with AIS who underwent ERT for cervicocephalic occlusions were consecutively enrolled into the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective (ASIAN KR) registry from 3 hospitals. Patients were excluded if onset to puncture time over 8 hours, in-hospital stroke, or unavailable 3-month mRS. DM was diagnosed if a patient had the history, or hemoglobin A1c on admission was over 6.5. Univariate analysis was performed to compare the characteristics between DM and non-DM population. Multiple logistic regression analysis was used to validate the effect of comorbid DM on 3 month outcomes. Results: Of 721 patients, 667 (93%) were finally included, with 233 DM patients and 434 non-DM patients. In the univariate analysis, comorbidity with hypertension (71.2% vs. 58.3%, p=0.001) and dyslipidemia (36.7% vs. 26.7%, p=0.012) were more frequent in the DM population. Periprocedural factors such as target vessels, intravenous thrombolysis, and final reperfusion grades did not differ. Good outcomes with mRS 0-2 were less frequent in the DM population (43.3% vs. 53.7%, p=0.011). In the logistic regression analysis adjusting age, male sex, initial NIHSS, premorbid mRS, hypertension history, atrial fibrillation, intravenous thrombolysis, onset to puncture time and successful reperfusion, DM was an independent predictor of poor outcomes (mRS 3-6; 1.933, 1.274-2.933, p=0.002). Conclusion: In patients receiving ERT for AIS due to cervicocephalic artery occlusions, the presence of DM as a comorbidity confers greater odds of a poor functional outcome.

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Exploring the impact of intravenous thrombolysis on length of stay for acute ischemic stroke: a retrospective cohort study

BMC Health Services Research ◽

10.1186/s12913-015-1080-0 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 3

Author(s):

Ling-Chien Hung ◽

Ya-Han Hu ◽

Sheng-Feng Sung

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Intravenous Thrombolysis ◽

The Impact

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Management of acute ischemic stroke

BMJ ◽

10.1136/bmj.l6983 ◽

2020 ◽

pp. l6983 ◽

Cited By ~ 15

Author(s):

Michael S Phipps ◽

Carolyn A Cronin

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

Recurrent Stroke ◽

Time Windows ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Developed Countries ◽

Future Research ◽

The Impact

ABSTRACT Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.

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Red Cell Distribution Width Before Intravenous Thrombolysis in Prediction of 1-year Outcome and Mortality in Patients with Acute Ischemic Stroke

10.21203/rs.2.9847/v1 ◽

2019 ◽

Author(s):

Weiyi Ye ◽

Jia Li ◽

Xiang LI ◽

Xuezhi Yang ◽

Yiyun Weng ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Cell ◽

Acute Ischemic Stroke ◽

Red Blood Cell ◽

Survival Function ◽

Intravenous Thrombolysis ◽

Cox Proportional Hazards ◽

Cell Distribution ◽

Distribution Width ◽

The Impact

Abstract Background: It is well known that red blood cell distribution width(RDW)is a parameter reflecting the heterogeneity of red blood cell volume，which recently may be associated with the development of cardiovascular events or mortality in patients after myocardial infarction .However, little is known about the association between RDW and stroke, especially regarding indisputable endpoints such as death. The purpose of the study was to explore the prognostic value of RDW and its effect on mortality among patients with acute ischemic stroke (AIS) undergoing Intravenous thrombolysis (IVT). Methods: We carried out retrospective analysis of acute anterior ischemic strokes cases treated with IVT between January 2016 and March 2018.The effect of RDW on poor outcome (modified Rankin score 3-6) and mortality in 1 year were assessed. Use multivariate logistic regression to explore the predictors. Receiver operating characteristic (ROC) curve was used to evaluate the predictive capability of variables, furthermore, we applied Cox proportional-hazards models to analyze the impact of factors on survival. Results: RDW (Multivariate OR 1.179;95%CI 0.900-1.545,p=0.232) was not associated with clinical outcome. Surviving patients have lower baseline RDW compared with patients who later died. Adding RDW to NIHSS could improve the prediction of the mortality of stroke clinical outcomes. Conclusions: The finding of our study implied that higher RDW was a potential predictive factor of mortality in 1 year in patients with AIS undergoing IVT，but RDW might not be associated with worse survival function among stroke survivors.

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The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis

PLoS ONE ◽

10.1371/journal.pone.0185589 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0185589 ◽

Cited By ~ 9

Author(s):

Florica Gadalean ◽

Mihaela Simu ◽

Florina Parv ◽

Ruxandra Vorovenci ◽

Raluca Tudor ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

The Impact

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Sex and Hemisphere - A Neglected, Nature-Determined Relationship in Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000430999 ◽

2015 ◽

Vol 40 (1-2) ◽

pp. 59-66 ◽

Cited By ~ 3

Author(s):

Christian Hametner ◽

Peter Ringleb ◽

Lars Kellert

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Specific Treatment ◽

Intravenous Thrombolysis ◽

Ordinal Regression ◽

Matched Cohort ◽

Exact Matching ◽

Stroke Patients ◽

Good Outcome ◽

The Impact

Background: Sex differences in the structural connectome of the brain are clinically highly relevant, but they have mostly been neglected in stroke trials. We investigated the impact of the interaction sex-by-hemisphere on outcome in stroke patients after intravenous thrombolysis (IVT). Methods: This is an observational study based on consecutively collected supratentorial stroke patients treated with IVT (n = 1,231). The 3-month modified Rankin scale (mRS) was estimated by adjusted binary (mRS 0-2 for good outcome) and ordinal regression analysis. As baseline characteristics differ substantially between the sexes, we aimed for better covariate balance by employing coarsened exact matching. Results: Sex-by-hemisphere predicted good outcome in the entire cohort (726 left, 505 right hemispheric strokes, p valueinteraction 0.032) and in the matched cohort (338 left, 273 right, p valueinteraction 0.003). Ordinal regression suggested a comparable estimate in the matched cohort (p valueinteraction 0.006). Further investigation revealed relevant between-sex and within-sex risk: right hemispheric strokes in men were 1.54 times (95% confidence intervals (CIs) 1.15-2.01) more likely than in women to achieve mRS 0-2. Women with right hemispheric strokes were 0.72 times (95% CI 0.54-0.92) less likely to reach mRS 0-2 than women with left hemispheric strokes. Conversely, men with right hemispheric strokes were 1.35 times (95% CI 1.06-1.70) more likely to achieve mRS 0-2 than men with left hemispheric strokes. Conclusion: This study suggests that outcomes are different in both sexes after IVT when different hemispheres are affected. Further consideration of this hypothesis in clinical trials might help in guiding individualized, injury-specific treatment approaches for acute ischemic stroke.

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Unfavorable neurological outcome in diabetic patients with acute ischemic stroke is associated with incomplete recanalization after intravenous thrombolysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011643 ◽

2015 ◽

Vol 8 (4) ◽

pp. 342-346 ◽

Cited By ~ 7

Author(s):

Huan Tang ◽

Sheng Zhang ◽

Shenqiang Yan ◽

David S Liebeskind ◽

Jianzhong Sun ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neurological Outcome ◽

Independent Predictor ◽

Intravenous Thrombolysis ◽

Diabetic Patients ◽

Vessel Occlusion ◽

Neurological Outcomes ◽

New Diagnosis ◽

The Impact

ObjectiveTo assess the impact of diabetes on neurological outcome and recanalization in acute ischemic stroke (AIS) after intravenous thrombolysis (IVT).MethodsClinical data of 419 consecutive patients with AIS who received IVT between June 2009 and April 2014. Based on the medical history and new diagnosis, the patients were divided into groups with and without diabetes. Neurological outcomes at 24 h, 7 days and 3 months after IVT were evaluated. Favorable outcome was defined as National Institutes of Health Stroke Scale (NIHSS) score decrease ≥4 points from baseline or 0 at 24 h, NIHSS decrease ≥8 points or 0 at day 7, or modified Rankin scale ≤1 at 3 months after IVT. Recanalization on non-invasive imaging was evaluated in patients with large vessel occlusion (LVO) according to thrombolysis in myocardial infarction grades.ResultsAmong 419 patients, 98 (23.4%) had diabetes. Multivariable analyses showed that comorbidity of diabetes was an independent predictor of unfavorable outcome at 24 h (OR=0.534, 95% CI 0.316 to 0.903, p=0.019), at day 7 (OR=0.382, 95% CI 0.220 to 0.665, p=0.001), and at 3 months (OR=0.464, 95% CI 0.266 to 0.808, p=0.007). In patients with LVO, diabetes was an independent predictor of incomplete recanalization 24 h after IVT (OR=0.268, 95% CI 0.075 to 0.955, p=0.042).ConclusionsDiabetic patients with AIS had unfavorable neurological outcome, potentially linked to incomplete recanalization after IVT.

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The impact of selected cardiovascular factors on the safety and efficacy of intravenous thrombolysis for acute ischemic stroke in routine practice in a rural hospital

Medical Studies ◽

10.5114/ms.2018.78687 ◽

2018 ◽

Vol 34 (3) ◽

pp. 232-240 ◽

Cited By ~ 1

Author(s):

Aleksandra Wach-Klink ◽

Karol Paciura ◽

Alicja Zwadowska ◽

Małgorzata Adamczak ◽

Wioletta Strojewska ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Rural Hospital ◽

Routine Practice ◽

Safety And Efficacy ◽

The Impact

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The impact of intravenous thrombolysis in acute ischemic stroke in National Medical College, Kolkata: initial experience

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195240 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1855

Author(s):

Saikat Ghosh ◽

Manoj Kr. Mahata ◽

Sarbajit Das ◽

K. C. Ghosh ◽

R. Bhattacharya ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

P Value ◽

Mortality And Morbidity ◽

National Medical College ◽

Medical College ◽

National Medical ◽

The Impact ◽

Treatable Condition

Background: Acute ischemic stroke is a potentially treatable condition, if left untreated, lead to mortality and morbidity. This study was conducted to study clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (r-TPA-alteplase) and to measure the outcome of thrombolysis.Methods: Retrospective observational study of 54 patients who underwent thrombolysis for acute ischemic stroke at National Medical College, Kolkata over a period of one year.Results: There was statistically significant improvement in NIHSS (p value-0.000) after intravenous thrombolysis.Conclusions: IV thrombolysis is feasible for AIS in governmental hospital in India.

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High glycemic albumin representing prestroke glycemic variability is associated with hemorrhagic transformation in patients receiving intravenous thrombolysis

Scientific Reports ◽

10.1038/s41598-021-04716-4 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Sang-Hwa Lee ◽

Min Uk Jang ◽

Yerim Kim ◽

So Young Park ◽

Chulho Kim ◽

...

Keyword(s):

Regression Analysis ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Characteristic Curve ◽

Glycated Albumin ◽

Intravenous Thrombolysis ◽

Predictive Ability ◽

Glycemic Variability ◽

Hemorrhagic Transformation ◽

The Impact

AbstractWe evaluated the impact of prestroke glycemic variability estimated by glycated albumin (GA) on symptomatic hemorrhagic transformation (SHT) in patients with intravenous thrombolysis (IVT). Using a multicenter database, we consecutively enrolled acute ischemic stroke patients receiving IVT. A total of 378 patients were included in this study. Higher GA was defined as GA ≥ 16.0%. The primary outcome measure was SHT. Multivariate regression analysis and a receiver operating characteristic curve were used to assess risks and predictive ability for SHT. Among the 378 patients who were enrolled in this study, 27 patients (7.1%) had SHT as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SHTSITS). The rate of SHTSITS was higher in the higher GA group than in the lower GA group (18.0% vs. 1.6%, p < 0.001). A higher GA level (GA ≥ 16.0%) significantly increased the risk of SHTSITS (adjusted odds ratio [OR], [95% confidence interval, CI], 12.57 [3.08–41.54]) in the logistic regression analysis. The predictive ability of the GA level for SHTSITS was good (AUC [95% CI]: 0.83 [0.77–0.90], p < 0.001), and the cutoff value of GA in SHT was 16.3%. GA was a reliable predictor of SHT after IVT in acute ischemic stroke in this study.

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