Wenwen Zhang1, Skye Coote2, Tanya Frost2, Helen M Dewey3, Philip M C Choi3. 1. Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia. Electronic address: wenwenzhang1981@gmail.com. 2. Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia. 3. Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia; Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria 3128, Australia.
Abstract
BACKGROUND: Thrombolytic therapy in patients with pre-existing disability presenting with acute ischemic stroke (AIS) is controversial because of concerns regarding poor outcomes and futility of treatment. We hypothesized that a similar proportion of patients with and without pre-existing disability would return to their premorbid functional status following thrombolysis. METHODS: This was a retrospective study at a single high-volume academic primary stroke center. All patients with AIS treated with intravenous alteplase between January 2005 and July 2016 were included. Premorbid functional status was assessed using modified Rankin scale (mRS) and dichotomized as independent premorbid (mRS 0-1) or disabled premorbid (mRS 2-4) groups for comparison. Functional outcome was assessed by mRS at 90 days and compared between groups. RESULTS: Six hundred eighty patients independent premorbid (mean age 71.8 ± 13.1 years, 57.9% male) and 140 disabled premorbid (mean age 82.1 ± 8.7 years, 40.7% male) were included. Patients with pre-existing disability were older and had more vascular risk factors and more severe stroke on presentation (P < 0.05). A greater proportion of patients in the disabled premorbid group were dead at 90 days (35.7% versus 12.8%, P < 0.05). At 90 days, among patients with premorbid mRS 0, 1, 2, 3, and 4: 25%, 38%, 32%, 30%, and 25% of them returned to their respective premorbid mRS status. CONCLUSIONS: Irrespective of premorbid functional level, approximately one fourth to one third of thrombolyzed patients had returned to their premorbid functional levels at 90 days. Thrombolytic treatment should be considered in patients with mild-to-moderate pre-existing disability, taking into account the value placed on the chance of a return to premorbid functional status.
BACKGROUND: Thrombolytic therapy in patients with pre-existing disability presenting with acute ischemic stroke (AIS) is controversial because of concerns regarding poor outcomes and futility of treatment. We hypothesized that a similar proportion of patients with and without pre-existing disability would return to their premorbid functional status following thrombolysis. METHODS: This was a retrospective study at a single high-volume academic primary stroke center. All patients with AIS treated with intravenous alteplase between January 2005 and July 2016 were included. Premorbid functional status was assessed using modified Rankin scale (mRS) and dichotomized as independent premorbid (mRS 0-1) or disabled premorbid (mRS 2-4) groups for comparison. Functional outcome was assessed by mRS at 90 days and compared between groups. RESULTS: Six hundred eighty patients independent premorbid (mean age 71.8 ± 13.1 years, 57.9% male) and 140 disabled premorbid (mean age 82.1 ± 8.7 years, 40.7% male) were included. Patients with pre-existing disability were older and had more vascular risk factors and more severe stroke on presentation (P < 0.05). A greater proportion of patients in the disabled premorbid group were dead at 90 days (35.7% versus 12.8%, P < 0.05). At 90 days, among patients with premorbid mRS 0, 1, 2, 3, and 4: 25%, 38%, 32%, 30%, and 25% of them returned to their respective premorbid mRS status. CONCLUSIONS: Irrespective of premorbid functional level, approximately one fourth to one third of thrombolyzed patients had returned to their premorbid functional levels at 90 days. Thrombolytic treatment should be considered in patients with mild-to-moderate pre-existing disability, taking into account the value placed on the chance of a return to premorbid functional status.
Authors: Sanjana Salwi; Shawna Cutting; Alan D Salgado; Kiersten Espaillat; Matthew R Fusco; Michael T Froehler; Rohan V Chitale; Howard Kirshner; Matthew Schrag; Adam Jasne; Tina Burton; Brian MacGrory; Ali Saad; Mahesh V Jayaraman; Tracy E Madsen; Katarina Dakay; Ryan McTaggart; Shadi Yaghi; Pooja Khatri; Akshitkumar M Mistry; Eva A Mistry Journal: Stroke Date: 2020-04-09 Impact factor: 7.914
Authors: Robert W Regenhardt; Michael J Young; Mark R Etherton; Alvin S Das; Christopher J Stapleton; Aman B Patel; Michael H Lev; Joshua A Hirsch; Natalia S Rost; Thabele M Leslie-Mazwi Journal: J Neurointerv Surg Date: 2020-10-30 Impact factor: 8.572