Introduction Administration of intravenous thrombolytics (IVT) within 4.5 hoursof symptoms onset, prior to performing mechanical thrombectomy(MT) in patients with acute ischemic stroke (AIS) secondary tolarge vessel occlusion (LVO) is thoroughly studied and hassuggested to improve reperfusion rates and clinical outcomes. [1,2] The outcomes of combined IVT and MT in STEMI patientshavebeen studied comprehensively and revealed worsening clinicaloutcomes when a shorter Lapse of Time (LoT) isintroduced.[3,4]Those studies stemmed the question of whetherLoTbetween IVT and MT in AIS patients has any significance. We investigated the effects of theLoTbetween IVT and MT onoutcomes of MT revascularization, as well as on the functionaloutcomes in patient with AIS with LVO. Methods We performed a retrospective analysis ofgathereddataduring a 6‐year period (2016‐2021) for all ourpatients with AIS and LVO who received both IVT and MT. We analyzed the MT revascularization outcomes using thethrombolysis in cerebral infarction(TICI)scale, as well as thestroke functional outcomes using the modified Rankin Scale(mRS)at discharge and 90 days to detectany significant differencesin positive or negative direction.LoT was measured as minutes from tPA administration and reperfusion on a continuous scale. Nonparametric tests (Kruskal‐Wallis analysis of variance on ranks, K‐W H) were used to determine if there were differences between mRS at discharge and at 90 days (as an ordinal variable, possible score 0–6) based on LoT. Results A total of 48 patients who received both IVT and MT were includedin the study.Those included were primarilyBlack (57.1%) and male(59.2%). Mean age was62.5 years (sd = 15.5, range 21–89 years).Median minutes between tPA and reperfusion was 74 minutes (min‐max = 44‐143 minutes). There were no significant differences betweenmRSatdischarge (K‐W H = 5.13, p = 0.40), nor at 90 days (K‐W H = 8.71, p = 0.19) as a function of theLoTbetween IVT and MT. There were no significant differences between TICI scores, as afunction of theLoTbetween IVT and MT, (K‐W H = 5.49,p = 0.14). Conclusions In this study we compared the impact of the time differencebetween IVT and MT on revascularization and functionaloutcome in patients with AIS and LVO.Unlike the findings in STEMI, we did not detect any significant outcomedifferences in MT results (TICI scale) and functional outcomes(mRSat discharge and 90 days), when IVT was given at differentLoTbeforeMT.
Introduction Aim: The purpose of this study is to determine risk factors that contribute to a gender difference in Acute Ischemic Stroke (AIS) patients with a past medical history of heart failure(HF) excluded from recombinant tissue plasminogen activator (rtPA). Methods Methods: The data for this analysis was extracted from the stroke registry of a regional stroke center from January 2010 until June 2016 in Greenville, SC. Data was analyzed using the logistic regression to identify factors significantly associated with exclusion receiving rtPA therapy in the AIS‐HF patient population stratified by gender. Results Results:A total of 590 AIS patients with HF that presented with AIS were identified. Factorsassociated with exclusion from rtPA for males included past history of antidepressants (OR = 0.728, 95% CI, 0.264‐2.012, P < 0.541), previous history of coronary artery stenosis (OR = 0.269,95%, Cl, 0.077‐0.941, P < 0.040). Factors associated with exclusion for females included age over75(OR = 0.975, 95% CI, 0.949‐1.000, P < 0.054), and history of chronic renal failure (OR = 0.235,95% CI, 0.078‐0.708, P < 0.010). Conclusions Conclusion: Our study identified risk factors that can be managed to eliminate gender difference and improve the eligibly of AIS patients with a history of heart failure for thrombolytic therapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.