Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population

Delgado, Montserrat González; Michel, Patrik; Naves, Manuel; Maeder, Philippe; Reichhart, Marc; Wintermark, Max; Bogousslavsky, Julien

doi:10.1136/jnnp.2009.185363

Cited by 23 publications

(10 citation statements)

References 23 publications

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“…The influence of sex on the outcome after thrombolysis is a topic of controversy in recent publications. In accordance with our findings, men were approximately 3 times more likely to have good functional outcomes in the GAIN study [4] and Delgato et al [5] identified male sex as a factor for clinical improvement 48 h after intravenous thrombolysis. In contrast, no difference in outcome 90 days after stroke was found in the CASES [6] study in 1,110 thrombolyzed patients and the pooled analysis of the NINDS, ANLANTIS and ECASS (I and II) even showed that women benefited more from rt-PA compared with men [7].…”

Section: Discussionsupporting

confidence: 92%

Characteristics and Outcome of Patients with Early Complete Neurological Recovery after Thrombolysis for Acute Ischemic Stroke

Blinzler

Breuer²,

Huttner³

et al. 2010

Cerebrovasc Dis

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Background: Recombinant tissue plasminogen activator (rt-PA) is the only approved specific therapy for acute ischemic stroke. This study analyzes demographic and clinical characteristics of patients with early complete neurological recovery after thrombolysis. Methods: Data of 320 consecutive patients treated with rt-PA within 3 h of stroke onset at our facility between April 2006 and March 2009 were extracted from our prospective institutional stroke and thrombolysis database. Baseline demographic parameters, risk factors, clinical characteristics as well as neuroradiologic findings of patients with complete recovery 24 h after treatment and at hospital discharge were analyzed. Outcome was evaluated using the modified Rankin Scale at 90 days. Results: Thirty patients (9.4%) were asymptomatic 24 h after thrombolysis and 70 (22%) at hospital discharge. Patients with complete recovery were younger, more often male, had milder stroke symptoms, less often cardioembolic strokes, fewer bleeding complications and more often normal follow-up imaging. In addition, in-hospital time was shorter and these patients retained a better functional outcome at 90 days. Only 1 patient who had completely recovered at hospital discharge died during the follow-up time. In multivariate regression analysis, only the National Institute of Health Stroke Score (NIHSS) on admission was predictive for complete recovery at both examined time points. Conclusion: Rapid complete recovery can be achieved in up to a fifth of acute stroke patients treated with thrombolysis. These patients are younger and have milder strokes, less often with cardioembolic origin. Better outcome and lower mortality are sustained at 3 months.

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Section: Discussionsupporting

confidence: 92%

Characteristics and Outcome of Patients with Early Complete Neurological Recovery after Thrombolysis for Acute Ischemic Stroke

Blinzler

Breuer²,

Huttner³

et al. 2010

Cerebrovasc Dis

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“…Only few of the included studies reported causes other than sICH. Of these, the most frequently cited were malignant oedema, accounting from 14% to 27% of all END 24 causes,23 45 48 52 and early recurrent ischaemic stroke (so-called ERIS35 47), which accounted from 0.6% to 1.8% of all patients with acute strokes in two large studies (228–341 patients),35 47 excluding one potential outlier of 2.9% in a very small study of 34 patients 52. Thus, even after taking into account sICH, malignant oedema and ERIS, a large fraction of END 24 had no reported cause.…”

Section: Resultsmentioning

confidence: 99%

Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications

Seners

Turc

Oppenheim

et al. 2014

J Neurol Neurosurg Psychiatry

232

227

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Early neurological deterioration (END) following ischaemic stroke is a serious event with manageable causes in only a fraction of patients. The incidence, causes and predictors of END occurring within 24 h of acute ischaemic stroke (END24) have not been systematically reviewed. We systematically reviewed Medline and Embase from January 1990 to April 2013 for all studies on END24 following acute ischaemic stroke (<8 h from onset). We recorded the incidence and presumed causes of and factors associated with END24. Thirty-six studies were included. Depending on the definition used, the incidence of END24 markedly varied among studies. Using the most widely used change in National Institutes of Health Stroke Scale ≥4 definition, the pooled incidence was 13.8% following thrombolysis, ascribed to intracranial haemorrhage and malignant oedema each in ∼20% of these. As other mechanisms were rarely reported, in the majority no clear cause was identified. Few data on END24 occurring in non-thrombolysed patients were available. Across thrombolysed and non-thrombolysed samples, the strongest and most consistent admission predictors were hyperglycaemia, no prior aspirin use, prior transient ischaemic attacks, proximal arterial occlusion and presence of early CT changes, and the most consistent 24 h follow-up associated factors were no recanalisation/reocclusion, large infarcts and intracranial haemorrhage. Finally, END24 was strongly predictive of poor outcome. The above findings are discussed with emphasis on END without a clear mechanism. Data on incidence and predictors of the latter subtype is scarce, and future studies using systematic imaging protocols should address its underlying pathophysiology. This may in turn lead to rational preventative and therapeutic measures for this ominous event.

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“…The secondary outcome was early neurological deterioration, which was defined as an increase of 4 or more points in the National Institutes of Health Stroke Scale scores from baseline within 7 days after admission, excluding patients who died within 7 days 20, 21…”

Section: Methodsmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population

Abstract: Early clinical profiles of evolution in thrombolysed patients vary considerably. Even with CI, it is critical to maintain vessel permeability to avoid subsequent CW.

Cited by 23 publications

References 23 publications

Characteristics and Outcome of Patients with Early Complete Neurological Recovery after Thrombolysis for Acute Ischemic Stroke

Characteristics and Outcome of Patients with Early Complete Neurological Recovery after Thrombolysis for Acute Ischemic Stroke

Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

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