Factors associated with timing of early neurological improvement after thrombolysis for ischaemic stroke

Guettier, Sophie; Cogez, Julien; Bonnet, Anne‐Laure; Dean, Pja; Apoil, Marion; Tchoumi, Thierry; Dubuc, Lydie; Arzur, Julien; Sayette, Vincent de La; Kouassi, Léonard; Viader, Fausto; Touzé, Emmanuel

doi:10.1111/ene.12943

Cited by 8 publications

(5 citation statements)

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“…In a study by Guettier et al in 2016, neurological premature improvement at 1 hour and neurological improvement within the first 24 hours after treatment were defined by improving NIHSS by 40% of baseline. Of the 421 patients, 51% had a very early neurological recovery and 26% had a neurological early recovery 12 . In a study by Li et al (2013), primary neurological healing and continuous neurological healing in the first 24 hours were strong predictors of favorable outcome for 3 months in patients with acute ischemic stroke undergoing thrombolysis 15 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the efficacy of recombinant tissue plasminogen activators in improving clinical status of acute ischemic stroke: A randomized clinical trial in Iran

Khazaei

Goodarzi

et al. 2018

Biomed. Res. Ther.

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Background: Acute ischemic stroke is caused by blockage of a cerebral artery and is also known as cerebrovascular accident (CVA). Recombinant tissue plasminogen activator (rt-PA) therapy is effective in reducing early and long-term neurologic disabilities if it is started quickly. Therefore, the aim of this study was to determine the efficacy of treatment with recombinant tissue plasminogen activators in improving the clinical status of acute ischemic stroke. Methods: The current study was performed as a clinical trial of two groups- treatment and control (n=20 per group). The treatment group consisted of patients who received rt-PA, while the control group consisted of patients who did not receive rt-PA. For each group, evaluation of neurological disabilities following ischemic stroke was based off the National Institutes of Health Stroke Scale (NIHSS), for early assessment of disability on the third day of treatment), and off the modified Rankin Scale (MRS) at 90 days after stroke. The drug effect criterion was used to reduce the neurological disability or the difference in NIHSS on day 3 after treatment. Also, the duration of onset of symptoms until the arrival of the patients to the emergency room (ER), as well as the risk factors, complications and number of deaths in both groups, were recorded. Data obtained were analyzed by SPSS software. Results: The results of the study showed that the mean of ER arrival time, NIHSS before treatment, and NIHSS on day 3 of treatment in the control group was higher than that of the treatment group; the difference was statistically significant (P<0.05). The results also indicated that the probability of improvement of neurological disabilities in the experimental group was greater than that of the control group (relative risk (RR) =1.25). Additionally, the odds ratio (OR) for receiving rt-PA in the NIHSS positive treatment group compared to the control group was equal to 1/5 (OR=1.5). The results showed that 30% of the patients in the treatment group were treated with a complication. The mean of MRS was higher in the control group at 90 days after the stroke, compared with the treatment group. Conclusion: Treatment with rt-PA reduces the neurological disability in patients with ischemic stroke, since the mean of MRS is lower in the treatment group, compared with the control group, after 90 days of treatment.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the efficacy of recombinant tissue plasminogen activators in improving clinical status of acute ischemic stroke: A randomized clinical trial in Iran

Khazaei

Goodarzi

et al. 2018

Biomed. Res. Ther.

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“…All NIHSS scores were performed by certified stroke neurologists. Neurological improvement was defined retrospectively as a ≥40% decrease in NIHSS score at 24 hours in comparison to the baseline pretreatment score after the initiation of therapy [ 8 , 9 ]. Since none of NIHSS scores of the patients increased, the standard of neurological deterioration was not adopted.…”

Section: Methodsmentioning

confidence: 99%

Pentraxin-3 in Thrombolytic Therapy for Acute Ischemic Stroke: No Relation with Curative Effect and Prognosis

et al. 2018

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BackgroundPentraxin-3 (PTX3) is considered a high quality inflammatory marker of the severity and prognosis of several diseases, however, the value of PTX3 in thrombolytic therapy for acute ischemic stroke remains unclear and PTX3 is still controversial in evaluating the prognosis of stroke patients. In this study, we investigated the association of PTX3 with thrombolytic therapy in patients with acute ischemic stroke.Material/MethodsForty-seven stroke patients who received thrombolytic therapy within 4.5 hours after symptom onset were enrolled consecutively between July 2016 and June 2017. All the patients underwent multiphase CTA (computerized tomography angiography) or CT perfusion before thrombolysis with no indication for endovascular treatment. Initial and 24 hours of National Institute of Health Stroke Scale (NIHSS) scores and serum PTX3 level, stroke risk factors and predictors, and mRS (modified Rankin scale) at 3 months were collected prospectively. Predictors of thrombolytic therapy effect and long-term prognosis were investigated by univariate and multivariate logistic regression.ResultsThe 24 hour NIHSS score and the treatment time was associated with symptom improvement, while the PTX3 level had no association with neurological improvement and prognosis in stroke patients receiving thrombolytic therapy.ConclusionsPTX3 is not suitable to serve as an indicator of thrombolytic efficacy and had no association with long-term prognosis in stroke patients receiving thrombolytic therapy.

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“…The proven evidence-based safety and efficacy of mechanical thrombectomy in the management of acute ischaemic stroke have provoked interest in a search for any variables that would predict patients' long-term prognosis after modern recanalisation procedures. Initially, early neurological improvement was proposed as an accurate predictor of a favourable long-term outcome in stroke patients treated with intravenous thrombolysis or mechanical thrombectomy [1,2]. Most studies, however, define early neurological improvement as an improvement achieved 24 hours after the recanalisation procedure, and it can be argued that the patient's condition at that time is still relatively unstable.…”

Section: Introductionmentioning

confidence: 99%

Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy

Wrona,

Wróbel,

Popadynets

et al. 2024

Neurol Neurochir Pol.

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Introduction. This study aimed to identify predictors of 90-day good functional outcome (GFO) in patients with acute ischaemic stroke (AIS) who were treated with mechanical thrombectomy but did not achieve a delayed neurological improvement (DNI).Clinical rationale for the study. In-hospital neurological improvement in patients with AIS is consistently associated with long--term GFO. Patients who experience neither early nor delayed neurological improvement can still achieve long-term GFO, but predictors of such an outcome have not been studied. Material and methods.This single-centre retrospective study involved 307 patients with anterior circulation AIS treated with mechanical thrombectomy. Multiple clinical, biochemical, radiological, and treatment-related variables were collected and analysed. DNI on day 7 was defined as at least a 10-point reduction in the National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score < 2. GFO on day 90 was defined as a modified Rankin Scale (mRS) score ≤ 2. We compared the characteristics of patients with and without DNI, with special attention paid to patients who achieved 90-GFO despite a lack of DNI. Multivariate analyses were then performed to establish independent predictors of 90-day GFO among patients without DNI.Results. DNI occurred in 150 out of 307 patients (48.7%) and significantly increased the odds for 90-day GFO (odds ratio [OR]: 13.99; p < 0.001). Among patients without DNI, 41.4% achieved 90-day GFO. Younger age (OR: 0.96; 95% confidence interval [CI]: 0.93-0.99; p = 0.008), lower baseline NIHSS score (OR: 0.80; 95% CI: 0.73-0.89; p < 0.001), treatment with intravenous thrombolysis (OR: 3.06; 95% CI: 1.25-7.49; p = 0.014), lack of an undetermined aetiology (OR: 0.40; 95% CI: 0.16-0.998; p = 0.050), lack of pneumonia (OR: 0.08; 95% CI: 0.02-0.31; p < 0.001), and higher haemoglobin concentration on admission (OR: 1.31; 95% CI: 1.04-1.69; p = 0.024) were identified as predictors of 90-day GFO in this subgroup. Conclusion.Almost half of patients with AIS in anterior circulation treated with mechanical thrombectomy experience DNI, which is a good predictor of 90-day GFO. Furthermore, 40% of patients without DNI achieve 90-day GFO which can be independently predicted by younger age, lower baseline NIHSS score, treatment with intravenous thrombolysis, higher haemoglobin concentration on admission, lack of undetermined ischaemic stroke aetiology, and lack of pneumonia.

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Factors associated with timing of early neurological improvement after thrombolysis for ischaemic stroke

Abstract: Low serum creatinine levels are associated with VENI, suggesting that swiftness of the efficacy of rt-PA or of neurological recovery may depend on renal function.

Cited by 8 publications

References 7 publications

Evaluation of the efficacy of recombinant tissue plasminogen activators in improving clinical status of acute ischemic stroke: A randomized clinical trial in Iran

Evaluation of the efficacy of recombinant tissue plasminogen activators in improving clinical status of acute ischemic stroke: A randomized clinical trial in Iran

Pentraxin-3 in Thrombolytic Therapy for Acute Ischemic Stroke: No Relation with Curative Effect and Prognosis

Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy

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