BACKGROUND: Thrombolysis of ischemic stroke patients presenting with mild symptoms is controversial. AIM: We aimed to describe the clinical outcome and frequency of infarcts and symptomatic intracerebral hemorrhages on follow-up imaging of such thrombolysis-treated patients. METHODS: Our cohort included 1398 consecutive ischemic stroke patients treated with intravenous thrombolysis at the Helsinki University Central Hospital, years 1995-2010. We analyzed the patients according to baseline National Institutes of Health Stroke Scale: ≤2, 3-4, 5-6, and >6. In our institution, visualization of an artery occlusion or perfusion deficit is required for thrombolysis with National Institutes of Health Stroke Scale ≤ 2. We used univariate and multivariable methods to describe the cohort and study associations between the variables. Excellent three-month outcome was defined as modified Rankin Scale 0-1. RESULTS: Fifty-eight (4·1%) patients were treated with National Institutes of Health Stroke Scale ≤ 2, another 194 (13·6%) with 3-4 points, and 236 (16·5%) with 5-6 points. With National Institutes of Health Stroke Scale ≤ 2, 45 (78%) of the patients had excellent three-month outcome, achieved in 116 (59%) patients with National Institutes of Health Stroke Scale 3-4, in 130 (55%) with National Institutes of Health Stroke Scale 5-6, and in 241 (26%) with National Institutes of Health Stroke Scale > 6. Frequencies of symptomatic intracerebral hemorrhage (European Cooperative Acute Stroke Study-2) were 0%, 2·6%, 2·1%, and 8·1%, and visible infarcts on follow-up imaging 48%, 43%, 48%, and 74%, respectively. In patients with baseline National Institutes of Health Stroke Scale ≤ 6, poor outcome was associated with previous stroke, diabetes, elevated admission blood glucose, and development of intracerebral hemorrhage. CONCLUSIONS: Half of patients presenting with National Institutes of Health Stroke Scale 0-6 developed an infarction despite thrombolysis, and 40% had poor outcome, which was associated with glucose metabolism and hemorrhagic complications. Managing thrombolysis candidates with mild symptoms warrants individual consideration often supported by multimodal imaging.
BACKGROUND:Thrombolysis of ischemic strokepatients presenting with mild symptoms is controversial. AIM: We aimed to describe the clinical outcome and frequency of infarcts and symptomatic intracerebral hemorrhages on follow-up imaging of such thrombolysis-treated patients. METHODS: Our cohort included 1398 consecutive ischemic strokepatients treated with intravenous thrombolysis at the Helsinki University Central Hospital, years 1995-2010. We analyzed the patients according to baseline National Institutes of Health Stroke Scale: ≤2, 3-4, 5-6, and >6. In our institution, visualization of an artery occlusion or perfusion deficit is required for thrombolysis with National Institutes of Health Stroke Scale ≤ 2. We used univariate and multivariable methods to describe the cohort and study associations between the variables. Excellent three-month outcome was defined as modified Rankin Scale 0-1. RESULTS: Fifty-eight (4·1%) patients were treated with National Institutes of Health Stroke Scale ≤ 2, another 194 (13·6%) with 3-4 points, and 236 (16·5%) with 5-6 points. With National Institutes of Health Stroke Scale ≤ 2, 45 (78%) of the patients had excellent three-month outcome, achieved in 116 (59%) patients with National Institutes of Health Stroke Scale 3-4, in 130 (55%) with National Institutes of Health Stroke Scale 5-6, and in 241 (26%) with National Institutes of Health Stroke Scale > 6. Frequencies of symptomatic intracerebral hemorrhage (European Cooperative Acute Stroke Study-2) were 0%, 2·6%, 2·1%, and 8·1%, and visible infarcts on follow-up imaging 48%, 43%, 48%, and 74%, respectively. In patients with baseline National Institutes of Health Stroke Scale ≤ 6, poor outcome was associated with previous stroke, diabetes, elevated admission blood glucose, and development of intracerebral hemorrhage. CONCLUSIONS: Half of patients presenting with National Institutes of Health Stroke Scale 0-6 developed an infarction despite thrombolysis, and 40% had poor outcome, which was associated with glucose metabolism and hemorrhagic complications. Managing thrombolysis candidates with mild symptoms warrants individual consideration often supported by multimodal imaging.
Authors: J Pfaff; C Herweh; M Pham; S Schönenberger; S Nagel; P A Ringleb; M Bendszus; M Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2016-06-30 Impact factor: 3.825
Authors: Aleksandra Yakhkind; Ryan A McTaggart; Mahesh V Jayaraman; Matthew S Siket; Brian Silver; Shadi Yaghi Journal: Front Neurol Date: 2016-06-10 Impact factor: 4.003