Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke

Kimura, Kazumi; Iguchi, Yasuyuki; Yamashita, Shinji; Shibazaki, Kensaku; Kobayashi, Kazuto; Inoue, Takeshi

doi:10.1016/j.jns.2007.09.036

Cited by 88 publications

(83 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cardiac emboli have been previously linked to lower recanalization rates, probably because of the association with more severe strokes, larger thrombi, and older age, making them more resistant to recanalization. 10 Several studies have shown that women have worse outcomes in ischemic stroke, with a growing body of evidence relating these data to an enhanced resistance to IVrtPA in women. 11 The relative frequencies of recanalyzed and nonrecanalyzed patients and sICH after IVrtPA are similar to other study reports.…”

Section: Discussionmentioning

confidence: 99%

Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke

Martins

Sargento-Freitas

Silva

et al. 2016

Stroke

View full text Add to dashboard Cite

Classically, the relationship between systolic BP (SBP) and clinical outcome was described as U-or J shaped, with both high and low values of BP being independent prognostic factors for poor outcome.2,3 Nonetheless, these studies did not consider the recanalization state of the affected arterial territory, which may directly influence the hemodynamic response.The main objective of this study is to determine the relationship between BP during the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. Methods Study PopulationWe included consecutive patients with acute ischemic stroke from July 2009 to June 2015, treated with intravenous thrombolysis (IVrtPA) or intra-arterial therapies in our tertiary, university hospital in Portugal. The exclusion criteria were as follows: patients who had insufficient BP data (ie, incomplete BP readings in the first 24 hours poststroke due to patient death or early hospital transfer); unavailable information Background and Purpose-Historical stroke cohorts reported a U-or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. Methods-Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated.Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio-computed tomography.Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients. Results-We Conclusions-Systemic

show abstract

Section: Discussionmentioning

confidence: 99%

Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke

Martins

Sargento-Freitas

Silva

et al. 2016

Stroke

View full text Add to dashboard Cite

show abstract

“…4 There are theoretical reasons for questioning whether thrombolysis will have a different effect among patients with AF versus sinus rhythm. On the one hand, patients with AF may have old emboli which after reaching intracranial vessels are unlikely to dissolve with alteplase 5 ; on the other hand, they might have soft emboli formed at ruptured sites of membranous thrombi and that are at least in theory amenable to thrombolysis, whereas cholesterol emboli from carotid lesions, small-vessel occlusion, and other nonembolic causes of stroke should be less responsive to treatment. In association with the factors that may influence clot dissolution, the timing of restoration of blood flow and the abruptness could also have an influence on the risk of hemorrhagic transformation with or without thrombolysis.…”

mentioning

confidence: 99%

“…[5][6][7][8] However, they did not compare with a control group, which has not been given alteplase. Among the randomized controlled trials examining efficacy of alteplase in patients with stroke, results for the AF subgroup are described only for the European Cooperative Acute Stroke Study (ECASS) III and National Institute of Neurological Disorders and Stroke (NINDS) trials.…”

mentioning

confidence: 99%

Impact of Atrial Fibrillation on Outcome in Thrombolyzed Patients With Stroke

Frank

Fulton

Weimar

et al. 2012

Stroke

View full text Add to dashboard Cite

Background and Purpose-Atrial fibrillation has been considered a risk factor for poor outcome from acute stroke and may influence response to thrombolysis, although supporting data are limited due to potential confounding with age and stroke severity. Method-We assessed the association of atrial fibrillation and thrombolysis exposure with the modified Rankin Scale score distribution at 90 days among patients registered in a trials archive. We used an age and baseline National Institutes of Health Stroke Scale-adjusted Cochran-Mantel-Haenszel test to test significance (P) followed by proportional odds logistic regression analysis to estimate the ORs for improved modified Rankin Scale score. Results-Data were available for 7091 patients, of whom 3027 were thrombolyzed. A total of 1631 patients had a history of atrial fibrillation, of whom 639 were thrombolyzed. Among patients with atrial fibrillation, baseline severity was greater (median baseline National

show abstract

“…Previous results showed poor rate of early recanalization with a low rate of early major neurological improvement after rtPA administration. (Kimura et al, 2008) In contrast, recent encouraging results were reported by the Czeck multidisciplinary medical researchers. It appears that no initial statistical differences existed between the treated versus non-treated groups when 24 hour and 7 day clinical improvement or rate of achieved recanalizations were compared.…”

Section: Af and Stroke -The Studies And Surveysmentioning

confidence: 95%