BACKGROUND: The National Institute of Neurological Disorders and Stroke (NINDS) trial reported that stroke subtype (e.g., large-artery atherothrombosis, cardioembolism, and lacunae) does not affect response to IV thrombolytic treatment. However, these conclusions were based upon stroke subtypes determined prior to extensive diagnostic evaluation. Because such initial diagnoses are frequently inaccurate, the efficacy of IV recombinant tissue plasminogen activator (rt-PA) based upon verified specific stroke subtypes remains uncertain. METHODS: The records of consecutive acute stroke patients treated with IV rt-PA at two regional stroke centers were retrospectively reviewed. The final stroke subtype after complete diagnostic evaluation was determined. The relationship between final stroke subtype and response to thrombolytic therapy was then investigated and compared with the results reported in the NINDS trial. RESULTS: Ninety consecutive patients were studied. After adjusting for baseline NIH Stroke Scale scores, no significant difference in final outcome based on confirmed stroke mechanism was identified. CONCLUSIONS: These data are consistent with those of the NINDS trial that reported that the efficacy of IV thrombolysis within the 3-hour time window is similar between different stroke subtypes. Based upon these data, allocating treatment of stroke patients with IV rt-PA based upon presumed stroke mechanism may be unnecessary. Such testing may result in time delays that could compromise the efficacy of treatment.
BACKGROUND: The National Institute of Neurological Disorders and Stroke (NINDS) trial reported that stroke subtype (e.g., large-artery atherothrombosis, cardioembolism, and lacunae) does not affect response to IV thrombolytic treatment. However, these conclusions were based upon stroke subtypes determined prior to extensive diagnostic evaluation. Because such initial diagnoses are frequently inaccurate, the efficacy of IV recombinant tissue plasminogen activator (rt-PA) based upon verified specific stroke subtypes remains uncertain. METHODS: The records of consecutive acute strokepatients treated with IV rt-PA at two regional stroke centers were retrospectively reviewed. The final stroke subtype after complete diagnostic evaluation was determined. The relationship between final stroke subtype and response to thrombolytic therapy was then investigated and compared with the results reported in the NINDS trial. RESULTS: Ninety consecutive patients were studied. After adjusting for baseline NIH Stroke Scale scores, no significant difference in final outcome based on confirmed stroke mechanism was identified. CONCLUSIONS: These data are consistent with those of the NINDS trial that reported that the efficacy of IV thrombolysis within the 3-hour time window is similar between different stroke subtypes. Based upon these data, allocating treatment of strokepatients with IV rt-PA based upon presumed stroke mechanism may be unnecessary. Such testing may result in time delays that could compromise the efficacy of treatment.
Authors: Lauren A Beslow; Scott E Kasner; Sabrina E Smith; Michael T Mullen; Matthew P Kirschen; Rachel A Bastian; Michael M Dowling; Warren Lo; Lori C Jordan; Timothy J Bernard; Neil Friedman; Gabrielle DeVeber; Adam Kirton; Lisa Abraham; Daniel J Licht; Abbas F Jawad; Jonas H Ellenberg; Ebbing Lautenbach; Rebecca N Ichord Journal: Stroke Date: 2011-11-10 Impact factor: 7.914
Authors: J M Niesten; I C van der Schaaf; G J Biessels; A E van Otterloo; T van Seeters; A D Horsch; M J A Luitse; Y van der Graaf; L J Kappelle; W P T M Mali; B K Velthuis Journal: Neuroradiology Date: 2013-06-21 Impact factor: 2.804
Authors: Martin Griebe; Elisabeth Fischer; Micha Kablau; Philipp Eisele; Marc E Wolf; Anastasios Chatzikonstantinou; Achim Gass; Michael G Hennerici; Kristina Szabo Journal: J Neurol Date: 2013-12-24 Impact factor: 4.849
Authors: Thabele M Leslie-Mazwi; Thomas G Brott; Robert D Brown; Bradford B Worrall; Scott L Silliman; L Douglas Case; Michael R Frankel; Stephen S Rich; James F Meschia Journal: J Stroke Cerebrovasc Dis Date: 2007 Sep-Oct Impact factor: 2.136