Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke

Muruet, Walter; Rudd, Anthony; Wolfe, Charles D A; Douiri, Abdel

doi:10.1161/strokeaha.117.019889

Cited by 52 publications

(25 citation statements)

References 34 publications

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“…If a patient survives the perilous first 1−3 months after basilar artery occlusion (BAO), it is not known how this translates into long‐term survival. Successful recanalization therapy is crucial in BAO, since the prognosis of untreated patients is abysmal with acute mortality of 85%–97% [1–4] Even though diagnostics and treatment strategies have undergone dramatic developments in recent years (including novel mechanical endovascular approaches), good outcome is achieved only by one‐third of patients [2,4–8] Data on long‐term survival and mortality after ischemic stroke are scarce and limited data on changes in outcome trends exist [9–13] Furthermore, only a few studies reporting long‐term outcome separately for BAO are available [5,14,15]…”

Section: Introductionmentioning

confidence: 99%

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

Ritvonen

Sairanen

Silvennoinen

et al. 2020

Euro J of Neurology

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Background The data on long‐term outcome after basilar artery occlusion (BAO) are scarce. Little is known about BAO survivors´ outcome over decades. Aim We set out to investigate long‐term survival and causes of death in BAO patients with up to two decades of follow‐up. We also evaluated differences in outcome trends. Methods Two hundred and seven BAO patients treated with intravenous thrombolysis (IVT) at the Department of Neurology, Helsinki University Hospital, between 1995 and 2016, were analyzed. Short‐term outcome was assessed by modified Rankin Scale (mRS) at 3 months. Long‐term cumulative survival rate was analyzed using Kaplan−Meier analysis. Factors associated with mortality were analyzed with Cox regression. Results Moderate outcome (mRS 0–3) was achieved in 41.1% and good outcome (mRS 0–2) in 30.4% of patients at 3 months. Three‐month mortality was 39.6%, of which 89% died within the first month. The median follow‐up time in 3‐month survivors was 8.9 years (maximum 21.8 years). Total mortality during follow‐up was 52.2%. Cumulative mortality rate was 25.7%. Older age, coronary artery disease and more extensive ischemic changes on admission brain imaging were independently associated with long‐term mortality. After the acute phase, the rate of other vascular causes of death increased in relation to stroke. Conclusions The described evolution of a large, single‐center BAO cohort shows a trend towards a higher rate of good and/or moderate outcome during later years in IVT‐treated patients. Survivors showed relative longevity, and the rate of cardiac and other vascular causes of death increased in relation to stroke sequelae over the long term.

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Section: Introductionmentioning

confidence: 99%

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

Ritvonen

Sairanen

Silvennoinen

et al. 2020

Euro J of Neurology

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“…Intravenous tissue plasminogen activator (rtPA) is recommended for acute ischemic stroke within the time window [3, 4]. It is proven to be effective to save neurological functions against stroke in clinical practice, and it has become a keystone of acute stroke treatment [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Luan

Zhang

Yang

et al. 2019

Behavioural Neurology

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Objectives. Unknown onset stroke (UOS) is usually excluded from intravenous thrombolysis concerning the unclear symptom onset time. Attempts have been done to use thrombolytic therapy in these patients. The current meta-analysis was done to examine the efficacy and safety of intravenous thrombolysis in UOS. Methods. PubMed, Web of Science, and Cochrane Library were searched for studies comparing thrombolysis with conservative therapy among UOSs. Data of good outcome (mRS, 0-2), mortality, and intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) were extracted and analyzed using the Revman 5.2 software. Results. In total, 8 studies with 1271 subjects (542 with thrombolysis and 729 with conservative therapy) were included in this meta-analysis. The data showed that patients receiving thrombolysis had a higher incidence of 90-day good outcome (P=0.0005) than conservative therapy. The comparison of discharge (P=0.89) and 90-day mortality (P=0.10) in both groups did not find any significances. The incidences of ICH (P=0.42) and sICH (P=0.06) were relatively comparable between the two therapies. Conclusions. Intravenous thrombolysis is a better choice for UOS patients for its efficacy and safety. In addition, pretreatment imaging assessment is beneficial for improving the efficacy of thrombolytic therapy. However, it needs more supporting evidences for clinical use in the future.

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“…Acute recanalization therapies have a positive effect on functional deficits after stroke ( 21 , 22 ). In the present study, these highly effective therapies strongly impacted short-term functional deficits, with a significant improvement of NIHSS and mRS values in patients with recanalization therapy.…”

Section: Discussionmentioning

confidence: 99%

Changes of Health-Related Quality of Life Within the 1st Year After Stroke–Results From a Prospective Stroke Cohort Study

et al. 2021

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Introduction: As prospective data on long-term patient-reported outcome measures (PROMs) to assess Health related Quality of Life (HRQoL) after stroke are still scarce, this study examined the long-term course of PROMs and investigated influential factors such as recanalization therapies.Materials and Methods: A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled with a personal interview and chart review performed at index event. One hundred forty (15%) patients received thrombolysis (IVT) and 53 (5%) patients received endovascular therapy (ET) or both treatments as bridging therapy (BT). After 3 and 12 months, a follow-up was conducted using a postal questionnaire including subjective quality of life EQ-5D-5L (European Quality of Life 5 Dimensions). At all time-points, Modified Rankin Scale (mRS) was additionally used to quantify functional stroke severity. Differences between therapy groups were identified using post-hoc-tests. Linear and logistic regression analyses were used to identify predictors of outcomes.Results: Recanalization therapies were associated with significant improvements of NIHSS (National Institutes of Health Stroke Scale [regression coefficient IVT 1.21 (p = 0.01) and ET/BT 7.6; p = 0.001] and mRS (modified Rankin Scale) [regression coefficient IVT 0.83; p = 0.001 and ET/BT 2.0; p = 0.001] between admission and discharge compared to patients with stroke unit therapy only, with a trend toward improvement of EQ-5D after 12 months [regression coefficient 4.67 (p = 0.17)] with IVT. HRQoL was considerably impaired by stroke and increased steadily in 3- and 12-months follow-up in patients with (mean EQ-5D from 56 to 68) and without recanalization therapy (mean EQ-5D from 62 to 68). In severe strokes a major and significant improvement was only detected during period of 3 to 12 months (p = 0.03 in patients with and p = 0.005 in patients without recanalization therapy).Conclusions: Despite significant and continuous improvements after stroke the HRQoL after 12 months remained below the age-matched general population, but was still unexpectedly high in view of the accumulation of permanent disabilities in up to 30% of the patients. Especially in severe strokes, it is important to evaluate HRQoL beyond a 3-months follow-up as improvements became significant only between 3 months and 1 year.

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Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke

Abstract: Supplemental Digital Content is available in the text.

Cited by 52 publications

References 34 publications

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

Outcomes and long‐term mortality after basilar artery occlusion—A cohort with up to 20 years’ follow‐up

Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Changes of Health-Related Quality of Life Within the 1st Year After Stroke–Results From a Prospective Stroke Cohort Study

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