Outcome of multimodal MRI-guided intravenous thrombolysis in patients with stroke with unknown time of onset

Zhao, Jie; Zhao, Hongmei; Li, Runtao; Li, Jiangtao; Liu, Chang; Lv, Juan; Li, Yanan; Liu, Wei; Ma, Dongpu; Hao, Huaihai; Xiao, Xinguang; Liu, Junzhong; Yin, Y. W. Katie; Liu, Rongli; Yu, Qi; Wei, Yingjie; Li, Pengyan; Wang, Yue; Wang, Runqing

doi:10.1136/svn-2018-000151

Cited by 11 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…And it turns out that the DNT time of patients with multimodal MRI was shortened [(61.23 ± 9.32) min vs. (87.22 ± 14.26) min], and mRS score and NIHSS score were reduced after treatment, suggesting that multimodal MRI could shorten DNT time, reduce the degree of neurological impairment, and improve the prognosis. It was consistent with relevant research results [ 19 , 20 ]. Multimode MRI includes DWI, PWI, etc.…”

Section: Discussionsupporting

confidence: 93%

Application of Multimodal Magnetic Resonance Imaging in Green Channel of Acute and Hyperacute Ischemic Stroke

Zhou¹,

Meng³

et al. 2022

Contrast Media & Molecular Imaging

View full text Add to dashboard Cite

The purpose of this study was to observe the effects of multimodal magnetic resonance imaging (MRI) in the green channel of acute and hyperacute ischemic strokes, in order to better guide clinical treatment. The clinical data of 126 patients with acute and hyperacute ischemic stroke who received interventional treatment in the emergency green channel was collected retrospectively. The patients who received multimodal computed tomography (CT) were included in the CT group. Patients who underwent multimodal MRI examinations were included in the MRI group, and the door-to-needle time (DNT), neurological function, and prognosis of the two groups were compared. The result turned out that among the 126 patients included, 40 patients underwent CT examination (CT group) and 86 patients underwent MRI examination (MRI group). A comparison of general data between the CT group and the MRI group showed P > 0.05 . The MRI group’s DNT time (61.23 ± 9.32) min was shorter than that of the CT group (87.22 ± 14.26) min, P < 0.05 . Through comparison, the P values of mRS scores and NIHSS scores in both groups were greater than 0.05. After treatment, the mRS score and NIHSS score of the MRI group was lower, with P < 0.05 . According to the results of this study, it can be concluded that emergency multimodal MRI could shorten the DNT time of patients with acute and hyperacute ischemic stroke, reduce the degree of neurological impairment, and improve the prognosis.

show abstract

Section: Discussionsupporting

confidence: 93%

Application of Multimodal Magnetic Resonance Imaging in Green Channel of Acute and Hyperacute Ischemic Stroke

Zhou¹,

Meng³

et al. 2022

Contrast Media & Molecular Imaging

View full text Add to dashboard Cite

show abstract

“…A total of 1757 patients were treated with tPA, and 12,260 were not. Mean patient ages were reported in 13 studies [4,5,22,24,26–34] and ranged from 63.9 to 78 years. Median patient ages were reported in three studies [23,25,35] and ranged from 69 to 75 years.…”

Section: Resultsmentioning

confidence: 99%

Thrombolytic therapy for wake‐up stroke: A systematic review and meta‐analysis

Grory

Saldanha

Mistry

et al. 2021

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose According to evidence‐based clinical practice guidelines, patients presenting with disabling stroke symptoms should be treated with intravenous tissue plasminogen activator (IV tPA) within 4.5 h of time last known well. However, 25% of strokes are detected upon awakening (i.e., wake‐up stroke [WUS]), which renders patients ineligible for IV tPA administered via time‐based treatment algorithms, because it is impossible to establish a reliable time of symptom onset. We performed a systematic review and meta‐analysis of the efficacy and safety of IV tPA compared with normal saline, placebo, or no treatment in patients with WUS using imaging‐based treatment algorithms. Methods We searched MEDLINE, Web of Science, and Scopus between January 1, 2006 and April 30, 2020. We included controlled trials (randomized or nonrandomized), observational cohort studies (prospective or retrospective), and single‐arm studies in which adults with WUS were administered IV tPA after magnetic resonance imaging (MRI)‐ or computed tomography (CT)‐based imaging. Our primary outcome was recovery at 90 days (defined as a modified Rankin Scale [mRS] score of 0–2), and our secondary outcomes were symptomatic intracranial hemorrhage (sICH) within 36 h, mortality, and other adverse effects. Results We included 16 studies that enrolled a total of 14,017 patients. Most studies were conducted in Europe (37.5%) or North America (37.5%), and 1757 patients (12.5%) received IV tPA. All studies used MRI‐based (five studies) or CT‐based (10 studies) imaging selection, and one study used a combination of modalities. Sixty‐one percent of patients receiving IV tPA achieved an mRS score of 0 to 2 at 90 days (95% confidence interval [CI]: 51%–70%, 12 studies), with a relative risk (RR) of 1.21 compared with patients not receiving IV tPA (95% CI: 1.01–1.46, four studies). Three percent of patients receiving IV tPA experienced sICH within 36 h (95% CI: 2.5%–4.1%; 16 studies), which is an RR of 4.00 compared with patients not receiving IV tPA (95% CI: 2.85–5.61, seven studies). Conclusions This systematic review and meta‐analysis suggests that IV tPA is associated with a better functional outcome at 90 days despite the increased but acceptable risk of sICH. Based on these results, IV tPA should be offered as a treatment for WUS patients with favorable neuroimaging findings.

show abstract

“…Často však v praxi při CRAO není zásobení přerušeno zcela a přežití retinálních buněk tak může být prodlouženo. Bylo popsáno, že rekanalizace až 270 minut (4,5 hodiny) od nástupu symptomů může alespoň část světločivných buněk zachránit [28][29][30][31][32][33]. Tato doba též koresponduje s časovým oknem pro podání trombolýzy u akutní ischemické CMP [6,7,24].…”

Section: Cévní Zásobení Sítnice a Patogeneze Craounclassified

Intravenous Thrombolytic Therapy for Acute Nonarteritic Central Retinal Artery Occlusion. A Review

Janská¹,

Bodnár²,

Jánský³

et al. 2022

CSO

View full text Add to dashboard Cite

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke. It is a critical condition that often leads to severe visual loss or blindness and can be a harbinger of further cerebrovascular events. Due to the lack of scientific data, there are no effective evidence-based forms of therapy for this condition. None of the conservative therapies have proven effective. The results of some previously published studies suggest a benefit of intravenous thrombolytic therapy in the same regimen as in the treatment of ischemic stroke. This work aims to present an overview of published clinical studies focused on the use of intravenous thrombolysis for CRAO, evaluate its efficacy and safety, and propose an optimal diagnostic and therapeutic algorithm for acute management of CRAO. Summary statistics of patient data from relevant studies indicate that a significant visual acuity improvement was achieved by a total of 45 % of patients receiving alteplase within 4.5 hours of symptoms onset. The occurrence of adverse events in this time window was not significant. Intravenous thrombolytic therapy in CRAO thus appears to be effective and safe. However, we still lack data from adequate prospective randomized controlled trials to confirm this conclusion. To date, two randomized trials are being conducted. The intravenous thrombolysis administration, patient monitoring, etiologic workup, and setting of effective secondary prevention should be ensured at the centre of highly specialized cerebrovascular care. Urgent transport of the CRAO patient to the nearest centre is essential.

show abstract

Outcome of multimodal MRI-guided intravenous thrombolysis in patients with stroke with unknown time of onset

Cited by 11 publications

References 20 publications

Application of Multimodal Magnetic Resonance Imaging in Green Channel of Acute and Hyperacute Ischemic Stroke

Application of Multimodal Magnetic Resonance Imaging in Green Channel of Acute and Hyperacute Ischemic Stroke

Thrombolytic therapy for wake‐up stroke: A systematic review and meta‐analysis

Intravenous Thrombolytic Therapy for Acute Nonarteritic Central Retinal Artery Occlusion. A Review

Contact Info

Product

Resources

About