Long-term Prognosis of Patients Who Contraindicated for Intravenous Thrombolysis in Acute Ischemic Stroke

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

Dehydration is a strong predictor of long-term prognosis of thrombolysed patients with acute ischemic stroke

Brain and Behavior ◽

10.1002/brb3.849 ◽

2017 ◽

Vol 7 (11) ◽

pp. e00849 ◽

Cited By ~ 5

Author(s):

Sha-Sha Li ◽

Ming-Ming Yin ◽

Zhong-He Zhou ◽

Hui-Sheng Chen

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Strong Predictor ◽

Long Term Prognosis

Download Full-text

Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.117.018140 ◽

2017 ◽

Vol 48 (10) ◽

pp. 2723-2730 ◽

Cited By ~ 24

Author(s):

Jinkwon Kim ◽

Hye Sun Lee ◽

Chung Mo Nam ◽

Ji Hoe Heo

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Long Term Prognosis

Download Full-text

Effect of stroke screening survey on intravenous thrombolysis and long-term outcomes in acute ischemic stroke patients: the real- world evidence from Shanghai, China

Annals of Translational Medicine ◽

10.21037/atm-21-1971 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Fen Li ◽

Yuqian Chen ◽

Lan Hong ◽

Bifan Zhu ◽

Duo Chen ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Real World ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Long Term Outcomes ◽

The Real ◽

Real World Evidence ◽

Screening Survey

Download Full-text

Decreased clot burden is associated with factor XIII Val34Leu polymorphism and better functional outcomes in acute ischemic stroke patients treated with intravenous thrombolysis

PLoS ONE ◽

10.1371/journal.pone.0254253 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254253

Author(s):

István Szegedi ◽

Rita Orbán-Kálmándi ◽

Attila Nagy ◽

Ferenc Sarkady ◽

Nikolett Vasas ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Factor Xiii ◽

Independent Predictor ◽

Univariate Analysis ◽

Intravenous Thrombolysis ◽

Carrier Status ◽

Clot Burden

Background Intravenous thrombolysis using recombinant tissue plasminogen activator remains the mainstay treatment of acute ischemic stroke (AIS), although endovascular treatment is becoming standard of care in case of large vessel occlusions (LVO). To quantify the thrombus burden in LVO, a semiquantitative CT angiography (CTA) grading system, the clot burden score (CBS) can be used. Here we aimed to study the association between CBS and various hemostasis parameters, and to evaluate which parameters are major determinants of thrombolysis outcome. Methods In this single-centered prospective observational case-control study, 200 anterior circulation AIS patients receiving intravenous thrombolysis treatment without thrombectomy were enrolled: 100 AIS patients with LVO (CBS 0–9) and 100 age- and sex-matched AIS patients without LVO (CBS 10). Fibrinogen, α2-plasmin inhibitor, plasminogen, factor XIII and D-dimer were assessed from blood samples taken before and 24 h after thrombolysis, and FXIII-A Val34Leu was genotyped. CBS was calculated using admission CTA. Short-term outcomes were defined based on the change in NIHSS by day 7, long-term outcomes were assessed according to the modified Rankin scale at 3 months post-event. Results Poor outcomes were significantly more frequent in the CBS 0–9 group. Plasminogen activity on admission was significantly higher in the CBS 0–9 group. In a univariate analysis, significant protective effect of the Leu34 allele against developing larger clots (CBS 0–9) could be demonstrated (OR:0.519; 95%CI:0.298–0.922, p = 0.0227). Multivariate regression analysis revealed that CBS is an independent predictor of short- and long-term functional outcomes, while such effect of the studied hemostasis parameters could not be demonstrated. Conclusions CBS was found to be a significant independent predictor of thrombolysis outcomes. FXIII-A Leu34 carrier status was associated with smaller thrombus burden, which is consistent with the in vitro described whole blood clot mass reducing effects of the allele, but the polymorphism had no effect on thrombolysis outcomes.

Download Full-text