Effect of Cardioembolic Etiology on Intravenous Thrombolysis Efficacy for Acute Ischemic Stroke

Abstract

Previous clinical studies suggest that intravenous (IV) recombinant tissue plasminogen activator (rt-PA) benefits stroke patients regardless of the underlying etiology. In this study, we assessed the possible differences in response to IV rt-PA between cardioembolic stroke and other stroke subtypes. A total of 303 consecutive stroke ischemic patients (from January 2005 to April 2014) admitted to our Stroke Unit and treated with IV rt-PA were retrospectively reviewed. All patients were classified in two groups: Cardioembolic (CE) and Non-Cardioembolic (NCE). We analyzed a total of 303 patients. Thirty patients died in the first hours after fibrinolysis and no statistically significant differences were found in two groups (14 CE vs 18 N-CE). We observed a significant differences in clinical outcome in terms of symptoms "improvement" (p< 0.01 .2) and symptoms" regression" (p<0.057 .2) even if this last result did not reach statistical significance in CE patients respect to N-CE patients. In conclusion, the intravenous fibrinolysis is more effective in CE group than in N-CE regarding symptoms "improvement" and the PFO-Stroke patients treated with fibrinolysis have better outcome than other patients and they have high rate of symptoms" regression". Moreover the main predictor of good outcomes were younger age and milder stroke severity on hospital admission.

The efficacy of systemic thrombolysis in patients with cardioembolic stroke

“…Это не противоречит данным других исследований [24], которые показали, что эффективность СТЛТ была сходна у пациентов с разными подтипами ИИ. Ряд авторов [25][26][27][28] связывают возможности реканализации окклюзированной артерии после СТЛТ, выживаемость и функциональный исход не с подтипом ИИ, а с влиянием таких факторов, как исходная тяжесть неврологического дефицита, особенность структуры ишемического очага по данным КТ, наличие анамнеза табакокурения.…”

Isolated Hand Palsy in National Institutes of Health Stroke Scale (NIHSS): Is It Useful?

“…The National Institutes of Health Stroke Scale (NIHSS) is a 42-point impairment scale that could be administered reliably by a variety of clinicians in a relatively short time to reveal neurological symptoms and signs in patients with stroke in a standardized manner. 2 , 3 , 4 The NIHSS provides an ordinal, nonlinear measure of acute stroke-related impairments by assigning numerical values to various aspects of neurological function. 2 , 3 This scale is used to quickly evaluate the stroke severity before and after each treatment.…”

“… 2 , 3 This scale is used to quickly evaluate the stroke severity before and after each treatment. 2 , 3 , 4 The NIHSS takes about six minutes to perform, with no need for additional equipment, and is easily executable after training in how to use it. 3 , 5 …”

“…In fact, the initial NIHSS score is a robust predictor of in-hospital complication and outcome at three months. 3 , 4 , 5 The validity of NIHSS derives from correlations with objective measures of stroke severity, such as size of infarct on imaging. 3 , 5 …”

“… 10 However, the use of diffusion-weighted magnetic resonance imaging could help clinicians diagnose ischemic stroke, including cerebral small ischemic lesions. 4 The delayed diagnosis of acute stroke or absence of thrombolytic therapy may induce the involvement of corticofugal tracts on arm and hand recovery with consequent disability. 11 One might question, however, whether the absence of this item for isolated hand palsy in NIHSS might underestimate the effect of thrombolytic therapy.…”