Nada Elsaid1, Guido Bigliardi2, Maria Luisa Dell'Acqua3, Laura Vandelli4, Ludovico Ciolli5, Livio Picchetto6, Giuseppe Borzì7, Riccardo Ricceri8, Roberta Pentore9, Stefano Vallone10, Stefano Meletti11, Ahmed Saied12. 1. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy; Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt. Electronic address: nadaabdelhameed@mans.edu.eg. 2. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: bigliardi.guido@aou.mo.it. 3. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: dellacqua.marialuisa@aou.mo.it. 4. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: vandelli.laura@aou.mo.it. 5. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: lud.ciolli@gmail.com. 6. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: picchetto.livio@aou.mo.it. 7. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: borzi.giuseppe@aou.mo.it. 8. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: ricceri.riccardo@aou.mo.it. 9. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: pentore.roberta@aou.mo.it. 10. Neuroradiology, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: Vallone.stefano@aou.mo.it. 11. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy. Electronic address: stefano.meletti@unimore.it. 12. Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Italy; Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt. Electronic address: ahmedeffat@mans.edu.eg.
Abstract
OBJECTIVES: the efficacy of delayed intravenous tissue plasminogen activator (tPA), beyond the 4.5 h window, is evolving. Advanced age and high admission National Institutes of Health Stroke Scale (NIHSS) score are proposed to adversely affect the outcome of delayed thrombolysis and limit the inclusion criteria. The summation of patient age and admission NIHSS score was introduced as the SPAN-100 index as a tool of prediction of the clinical outcome after acute ischemic stroke (AIS). We aimed to assess the SPAN-100 index in AIS thrombolysed patients after 4.5 h. MATERIALS AND METHODS: The SPAN-100 index was applied to AIS patients receiving delayed IV thrombolysis (IVT) after 4.5 h. Patients demographics, risk factors, clinical, laboratory and radiological data, mismatch evidence, treatment onset and modality, NIHSS score at baseline and at discharge, and 3 months follow-up modified Rankin Scale (mRS) were reviewed. SPAN-100 score ≥ 100 is classified as SPAN-100 positive while score < 100 is SPAN-100 negative. Clinical outcomes, death and intracerebral hemorrhage (ICH) incidences were compared between SPAN-100 positive and negative groups. RESULTS: SPAN-100-positive delayed IVT-patients (11/136) had a 6-fold increased risk for unfavorable outcome compared to SPAN-negative patients (OR 6.34; 95% CI 1.59-25.24 p=0.004), however there was no relation between the SPAN-100 positivity and mortality or ICH. CONCLUSION: SPAN-100-positive patients are more likely to achieve non-favorable outcome with delayed IVT in comparison to the SPAN-100-negative patients. SPAN-100 index may influence the eligibility criteria of delayed thrombolysis.
OBJECTIVES: the efficacy of delayed intravenous tissue plasminogen activator (tPA), beyond the 4.5 h window, is evolving. Advanced age and high admission National Institutes of Health Stroke Scale (NIHSS) score are proposed to adversely affect the outcome of delayed thrombolysis and limit the inclusion criteria. The summation of patient age and admission NIHSS score was introduced as the SPAN-100 index as a tool of prediction of the clinical outcome after acute ischemic stroke (AIS). We aimed to assess the SPAN-100 index in AIS thrombolysed patients after 4.5 h. MATERIALS AND METHODS: The SPAN-100 index was applied to AIS patients receiving delayed IV thrombolysis (IVT) after 4.5 h. Patients demographics, risk factors, clinical, laboratory and radiological data, mismatch evidence, treatment onset and modality, NIHSS score at baseline and at discharge, and 3 months follow-up modified Rankin Scale (mRS) were reviewed. SPAN-100 score ≥ 100 is classified as SPAN-100 positive while score < 100 is SPAN-100 negative. Clinical outcomes, death and intracerebral hemorrhage (ICH) incidences were compared between SPAN-100 positive and negative groups. RESULTS: SPAN-100-positive delayed IVT-patients (11/136) had a 6-fold increased risk for unfavorable outcome compared to SPAN-negative patients (OR 6.34; 95% CI 1.59-25.24 p=0.004), however there was no relation between the SPAN-100 positivity and mortality or ICH. CONCLUSION: SPAN-100-positive patients are more likely to achieve non-favorable outcome with delayed IVT in comparison to the SPAN-100-negative patients. SPAN-100 index may influence the eligibility criteria of delayed thrombolysis.