BACKGROUND AND PURPOSE: The use of thrombolysis in patients with minor neurological deficits and large vessel occlusion is controversial. METHODS: We compared the outcome of patients with low National Institutes of Health Stroke Scale (NIHSS) scores and large vessel occlusions between thrombolysed and non-thrombolysed patients. RESULTS: 88 (1.7%) of 5312 consecutive patients with acute (within 24 h) ischaemic stroke had occlusions of the internal carotid or the main stem of the middle cerebral artery and baseline NIHSS scores ≤5.47 (53.4%) were treated without thrombolysis, and 41 (46.6%) received intravenous thrombolysis, endovascular therapy or both. Successful recanalisation on MR or CT angiography at 24 h was more often observed in thrombolysed than in non-thrombolysed patients (78.9% versus 10.5%; p<0.001). Neurological deterioration (increase of NIHSS score ≥1 compared to baseline) was observed in 22.7% of non-thrombolysed versus 10.3% of thrombolysed after 24 h (p=0.002), in 33.3% versus 12.5% at hospital discharge (p=0.015) and in 41.4% versus 15% at 3 months (p<0.001). Symptomatic intracerebral haemorrhage occurred in two (asymptomatic in five) thrombolysed and in none (asymptomatic in three) non-thrombolysed. Thrombolysis was an independent predictor of favourable outcome (p=0.030) but not survival (p=0.606) at 3 months. CONCLUSIONS: Non-thrombolysed patients with mild deficits and large vessel occlusion deteriorated significantly more often within 3 months than thrombolysed patients. Symptomatic intracerebral haemorrhages occurred in less than 5% of patients in both groups. These data suggest that thrombolysis is safe and effective in these patients. Therefore, randomised trials in patients with large vessel occlusions and mild or rapidly improving symptoms are needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND AND PURPOSE: The use of thrombolysis in patients with minor neurological deficits and large vessel occlusion is controversial. METHODS: We compared the outcome of patients with low National Institutes of Health Stroke Scale (NIHSS) scores and large vessel occlusions between thrombolysed and non-thrombolysed patients. RESULTS: 88 (1.7%) of 5312 consecutive patients with acute (within 24 h) ischaemic stroke had occlusions of the internal carotid or the main stem of the middle cerebral artery and baseline NIHSS scores ≤5.47 (53.4%) were treated without thrombolysis, and 41 (46.6%) received intravenous thrombolysis, endovascular therapy or both. Successful recanalisation on MR or CT angiography at 24 h was more often observed in thrombolysed than in non-thrombolysed patients (78.9% versus 10.5%; p<0.001). Neurological deterioration (increase of NIHSS score ≥1 compared to baseline) was observed in 22.7% of non-thrombolysed versus 10.3% of thrombolysed after 24 h (p=0.002), in 33.3% versus 12.5% at hospital discharge (p=0.015) and in 41.4% versus 15% at 3 months (p<0.001). Symptomatic intracerebral haemorrhage occurred in two (asymptomatic in five) thrombolysed and in none (asymptomatic in three) non-thrombolysed. Thrombolysis was an independent predictor of favourable outcome (p=0.030) but not survival (p=0.606) at 3 months. CONCLUSIONS: Non-thrombolysed patients with mild deficits and large vessel occlusion deteriorated significantly more often within 3 months than thrombolysed patients. Symptomatic intracerebral haemorrhages occurred in less than 5% of patients in both groups. These data suggest that thrombolysis is safe and effective in these patients. Therefore, randomised trials in patients with large vessel occlusions and mild or rapidly improving symptoms are needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Authors: Nitin Goyal; Georgios Tsivgoulis; Konark Malhotra; Muhammad F Ishfaq; Abhi Pandhi; Michael T Frohler; Alejandro M Spiotta; Mohammad Anadani; Marios Psychogios; Volker Maus; Adnan Siddiqui; Muhammad Waqas; Peter D Schellinger; Marcel Groen; Christos Krogias; Daniel Richter; Maher Saqqur; Pablo Garcia-Bermejo; Maxim Mokin; Ronen Leker; Jose E Cohen; Aristeidis H Katsanos; Georgios Magoufis; Klearchos Psychogios; Vasileios Lioutas; Meg VanNostrand; Vijay K Sharma; Maurizio Paciaroni; Alexandros Rentzos; Hazem Shoirah; J Mocco; Christopher Nickele; Violiza Inoa; Daniel Hoit; Lucas Elijovich; Andrei V Alexandrov; Adam S Arthur Journal: JAMA Neurol Date: 2020-01-01 Impact factor: 18.302
Authors: Michael V Mazya; Charith Cooray; Kennedy R Lees; Danilo Toni; Gary A Ford; Michal Bar; Senta Frol; Tiago Moreira; Lakshmanan Sekaran; Viktor Švigelj; Nils Wahlgren; Niaz Ahmed Journal: Eur Stroke J Date: 2017-11-29
Authors: Meredith T Bowen; Leticia C Rebello; Mehdi Bouslama; Diogo C Haussen; Jonathan A Grossberg; Nicolas A Bianchi; Samir Belagaje; Aaron Anderson; Michael R Frankel; Raul G Nogueira Journal: Interv Neurol Date: 2017-11-23