Thrombolytic therapy and visuoperceptual functions in right hemisphere infarct patients

Laihosalo, Mari; Kettunen, Jani E; Koivisto, Anna‐Maija; Dastidar, Prasun; Ollikainen, Jyrki; Jehkonen, Mervi

doi:10.1007/s00415-010-5873-0

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…This is probably due to the different test methods used. At least until now, a benefit of the rtPA therapy with regard to visuoconstrictive abilities could be recognized [39].…”

Section: Discussionmentioning

confidence: 99%

Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke – an analysis of the German Stroke Registry

Ettelt¹,

Maier²,

Schnieder³

et al. 2020

Neurol. Res. Pract.

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Background: The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear. Methods: We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT). Results: Of the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%, p = 0.65). Median MoCA score in the EVT + IVT group was 20 pts. (18-25 IQR) vs. 18 pts. (16-21 IQR) in the EVT-IVT group (p = 0.014). There were more patients with cognitive impairment (defined as MoCA < 26 pts) in the EVT-IVT group (54 patients (86%)) compared to the EVT + IVT group (78 patients (76%)). EVT + IVT was associated with a higher MoCA score at 90 days (mRS ≤ 2: p = 0.033, B = 2.39; mRS = 0: p = 0.021, B = 4.38). Conclusions: In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone.

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“…This is probably due to the different test methods used. At least until now, a benefit of the rtPA therapy with regard to visuoconstrictive abilities could be recognized [39].…”

Section: Discussionmentioning

confidence: 99%

Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke – an analysis of the German Stroke Registry

Ettelt¹,

Maier²,

Schnieder³

et al. 2020

Neurol. Res. Pract.

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show abstract

“…12 However, it only included 3 studies, all with substantially smaller sample sizes (n=56-92) and none of them were population-based. [32][33][34] The authors were unable to estimate a reliable summary measure because of wide heterogeneity in the evaluation of cognition and short follow-up time windows. These studies evaluated different cognitive domains and ascertained outcomes very early after stroke (ie, 4 days, 3 months, 6 months).…”

Section: Discussionmentioning

confidence: 99%

“…These studies evaluated different cognitive domains and ascertained outcomes very early after stroke (ie, 4 days, 3 months, 6 months). 12,[32][33][34] To the best of our knowledge, no studies have further assessed the association between thrombolysis administration and dementia risk after the publication of the meta-analysis. Our study suggests that the administration of intravenous thrombolysis in patients with acute ischemic stroke is not only associated with increased odds of functional independence, 11 but also with reduced Mean person-years 6.2 5.9…”

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis After First-Ever Ischemic Stroke and Reduced Incident Dementia Rate

Cerasuolo

Mandzia

Cipriano

et al. 2022

Stroke

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Background and Purpose: The use of intravenous thrombolysis is associated with improved clinical outcomes. Whether thrombolysis is associated with reduced incidence of poststroke dementia remains uncertain. We sought to estimate if the use of thrombolysis following first-ever ischemic stroke was associated with a reduced rate of incident dementia using a pragmatic observational design. Methods: We included first-ever ischemic stroke patients from the Ontario Stroke Registry who had not previously been diagnosed with dementia. The primary outcome was incident dementia ascertained by a validated diagnostic algorithm. We employed inverse probability of treatment-weighted Cox proportional hazard models to estimate the cause-specific hazard ratio for the association of thrombolysis and incident dementia at 1 and 5 years following stroke. Results: From July 2003 to March 2013, 7072 patients with ischemic stroke were included, 3276 (46.3%) were female and mean age was 71.0 (SD, 12.8) years. Overall, 38.2% of the cohort (n=2705) received thrombolysis, 77.2% (n=2087) of which was administered within 3 hours of stroke onset. In the first year following stroke, thrombolysis administration was associated with a 24% relative reduction in the rate of developing dementia (cause-specific hazard ratio, 0.76 [95% CI, 0.58–0.97]). This association remained significant at 5 years (cause-specific hazard ratio, 0.79 [95% CI, 0.66–0.91]) and at the end of follow-up (median 6.3 years; cause-specific hazard ratio, 0.79 [95% CI, 0.68–0.89]). Conclusions: Thrombolysis administration following first-ever ischemic stroke was independently associated with a reduced rate of dementia. Incident dementia should be considered as a relevant outcome when evaluating risk/benefit of thrombolysis in ischemic stroke patients.

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“…Whereas early studies failed to show a positive effect of thrombolysis on the cognitive outcome, there is some evidence in later, more focused investigations, where intravenous thrombolysis was reported to be associated with less severe neuropsychological syndromes in patients who had a a first ischaemic stroke 3. In particular, this has been demonstrated for aphasia during the acute and postacute (3 months) stages of left middle cerebral artery infarction12 and for the severity of visuoperceptual dysfunction during the acute stage of right hemispheric infarction 13…”

Section: Thrombolysis and Thrombectomy: Decreasing The Severity Of Nementioning

confidence: 98%

Identifying patterns of cognitive deficits: the path to better outcomes after stroke

Clarke

2020

J Neurol Neurosurg Psychiatry

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Thrombolytic therapy and visuoperceptual functions in right hemisphere infarct patients

Cited by 9 publications

References 14 publications

Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke – an analysis of the German Stroke Registry

Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke – an analysis of the German Stroke Registry

Intravenous Thrombolysis After First-Ever Ischemic Stroke and Reduced Incident Dementia Rate

Identifying patterns of cognitive deficits: the path to better outcomes after stroke

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