Friedrich Medlin1, Michael Amiguet2, Peter Vanacker2, Patrik Michel2. 1. From the Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (F.M., P.M.); Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (M.A.); Department of Neurology, University Hospital Antwerp, Belgium (P.V.); and University of Lausanne, Lausanne, Switzerland (P.M.). friedrich.medlin@h-fr.ch. 2. From the Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (F.M., P.M.); Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (M.A.); Department of Neurology, University Hospital Antwerp, Belgium (P.V.); and University of Lausanne, Lausanne, Switzerland (P.M.).
Abstract
BACKGROUND AND PURPOSE: We aimed to assess the interaction between intravenous thrombolysis (IVT) and arterial occlusion on acute cervicocerebral computed tomographic angiography on the outcome of patients with acute ischemic stroke. METHODS: Patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry with onset-to-door-time ≤4 hours, acute cervicocerebral computed tomographic angiography, a premorbid modified Rankin Scale ≤2, and a National Institute of Health Stroke Scale (NIHSS) >4 were selected. Patients with significant intracranial arterial obstruction (≥50%-99%) and undergoing acute endovascular treatment were excluded. An interaction analysis of IVT and initial arterial occlusion for favorable 3 months outcome (modified Rankin Scale <3) were performed with adjustment for potential confounders. RESULTS: Among 654 included patients, 382 (58%) showed arterial occlusion, of whom 263 (69%) received IVT. Two hundred seventy-two showed no/minimal obstruction of whom 139 (51%) received IVT. In the adjusted interaction analysis, there was a trend in favor of the arterial occlusion group (odds ratio [OR]=3.97; 95% confidence interval [CI], 0.83-18.97; P=0.08). IVT (versus no IVT) was associated with better outcome in patients with occlusion (adjusted OR for favorable outcome, 3.01; 95% CI, 1.10-8.28) but not in patients with no/minimal obstruction (OR, 0.76; 95% CI, 0.21-2.74). Conversely, patients with occlusion had a similar rate of favorable outcome as no/minimal obstruction when thrombolysed (OR, 0.5; 95% CI, 0.17-1.47) but had a less favorable outcome without thrombolysis (OR, 0.13; 95% CI, 0.04-0.44). CONCLUSIONS: In this retrospective analysis of consecutive patients with acute ischemic stroke, there was a trend for more favorable outcomes with IVT in the setting of initial arterial occlusion than in the setting of no/minimal obstruction. Before confirmation in randomized controlled studies, this information should not influence thrombolysis decisions, however.
BACKGROUND AND PURPOSE: We aimed to assess the interaction between intravenous thrombolysis (IVT) and arterial occlusion on acute cervicocerebral computed tomographic angiography on the outcome of patients with acute ischemic stroke. METHODS:Patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry with onset-to-door-time ≤4 hours, acute cervicocerebral computed tomographic angiography, a premorbid modified Rankin Scale ≤2, and a National Institute of Health Stroke Scale (NIHSS) >4 were selected. Patients with significant intracranial arterial obstruction (≥50%-99%) and undergoing acute endovascular treatment were excluded. An interaction analysis of IVT and initial arterial occlusion for favorable 3 months outcome (modified Rankin Scale <3) were performed with adjustment for potential confounders. RESULTS: Among 654 included patients, 382 (58%) showed arterial occlusion, of whom 263 (69%) received IVT. Two hundred seventy-two showed no/minimal obstruction of whom 139 (51%) received IVT. In the adjusted interaction analysis, there was a trend in favor of the arterial occlusion group (odds ratio [OR]=3.97; 95% confidence interval [CI], 0.83-18.97; P=0.08). IVT (versus no IVT) was associated with better outcome in patients with occlusion (adjusted OR for favorable outcome, 3.01; 95% CI, 1.10-8.28) but not in patients with no/minimal obstruction (OR, 0.76; 95% CI, 0.21-2.74). Conversely, patients with occlusion had a similar rate of favorable outcome as no/minimal obstruction when thrombolysed (OR, 0.5; 95% CI, 0.17-1.47) but had a less favorable outcome without thrombolysis (OR, 0.13; 95% CI, 0.04-0.44). CONCLUSIONS: In this retrospective analysis of consecutive patients with acute ischemic stroke, there was a trend for more favorable outcomes with IVT in the setting of initial arterial occlusion than in the setting of no/minimal obstruction. Before confirmation in randomized controlled studies, this information should not influence thrombolysis decisions, however.
Authors: Wolfgang G Kunz; Wieland H Sommer; Lukas Havla; Franziska Dorn; Felix G Meinel; Olaf Dietrich; Grete Buchholz; Birgit Ertl-Wagner; Kolja M Thierfelder Journal: Eur Radiol Date: 2016-10-08 Impact factor: 5.315
Authors: Grant Mair; Rüdiger von Kummer; Alessandro Adami; Philip M White; Matthew E Adams; Bernard Yan; Andrew M Demchuk; Andrew J Farrall; Robin J Sellar; Eleni Sakka; Jeb Palmer; David Perry; Richard I Lindley; Peter A G Sandercock; Joanna M Wardlaw Journal: Stroke Date: 2016-12-22 Impact factor: 7.914
Authors: Huiqiao Tian; Mark W Parsons; Christopher R Levi; Xin Cheng; Richard I Aviv; Neil J Spratt; Timothy J Kleinig; Billy O'Brien; Kenneth S Butcher; Longting Lin; Jingfen Zhang; Qiang Dong; Chushuang Chen; Andrew Bivard Journal: Front Neurol Date: 2018-06-06 Impact factor: 4.003