Safe implementation of thrombolysis in stroke‐monitoring study in Italy

Lorenzano, Svetlana; Ahmed, Niaz; Rosselli, A; Marcello, Norina; Inzitari, Domenico; Sterzi, Roberto; Wahlgren, Nils; Prencipe, Massimiliano; Toni, Danilo

doi:10.1111/j.1468-1331.2009.02700.x

Cited by 9 publications

(7 citation statements)

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“…15 Several criteria for the definition of ICH exist, so the rates of total sICH ranged from 3.6 to 9.3% of cases for RCT studies and from 3 to 34.9% of cases for non-RCT studies, depending upon the patient selection and definition applied. [16][17][18] Moreover, only few non-RCT studies reported sICH International Journal of Stroke, 0(0) International Journal of Stroke, 0(0)…”

Section: Discussionmentioning

confidence: 99%

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Salsano

Pracucci

Mavilio

et al. 2020

International Journal of Stroke

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Background There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. Aims We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. Methods From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. Results The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21–2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13–8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66–12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31–0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97–0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19–0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6–0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02–1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02–1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25–2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26–3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08–2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55–0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. Conclusions Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.

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Section: Discussionmentioning

confidence: 99%

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Salsano

Pracucci

Mavilio

et al. 2020

International Journal of Stroke

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“…20 The safety and efficacy outcomes in our cohort were comparable with those of larger datasets of SITS registries. 4,10,[12][13][14][15][16] Compared with other cohorts, in the Greek cohort there was a trend towards a higher rates of 90-day FI (mRS 0-2) or FFO (mRS 0-1) and lower rates of mortality and sICH, particularly according to NINDS and ECASS definitions. This finding could probably be attributed to the younger age and lower median NIHSS scores at baseline of patients included in the Greek cohort (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…4 The efficacy outcomes assessed a reduction in the baseline NIHSS score at 2 and 24 h following tPA bolus, 3-month favorable functional outcome [FFO; defined as modified Rankin scale (mRS) scores of 0-1] and 3-month functional independence (FI; defined as mRS-scores of 0-2). 4,10,11 The safety and efficacy outcomes were evaluated comparatively with previously published data from the SITS registry in Italy, 12 Austria, 13 Belgium 14 and Poland, 15 the SITS-EAST 10 and the entire SITS-ISTR 16 databases. The participating counties in SITS-EAST registry include Croatia, Czech Republic, Estonia, Greece, Hungary, Lithuania, Poland, Russia, Slovakia, Slovenia and Turkey, representing approximately 30% of the population of the SITS registry.…”

Section: Methodsmentioning

confidence: 99%

Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience

Tsivgoulis

Kargiotis

Rudolf

et al. 2018

Ther Adv Neurol Disord

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Background:Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset.Methods:All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries.Results:A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries.Conclusions:Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.

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“…This has proved to be very popular, and many neurologists and clinical neuroscientists have indicated the value of being able quickly to scan a subspecialty area for relevant papers. Therefore we provide here a review of those papers published in 2010 [1–233].…”

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confidence: 99%

Publishing changes and information delivery in the clinical neurosciences

Schapira¹,

Hillbom²

2011

European Journal of Neurology

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Safe implementation of thrombolysis in stroke‐monitoring study in Italy

Abstract: The SITS-MOST study showed that in Italy i.v. alteplase is safe and effective in routine clinical use also in non-expert centres.

Cited by 9 publications

References 9 publications

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience

Publishing changes and information delivery in the clinical neurosciences

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