Generalized Safety and Efficacy of Simplified Intravenous Thrombolysis Treatment (SMART) Criteria in Acute Ischemic Stroke: The MULTI SMART Study

Sorensen, Sigrid; Barazangi, Nobl; Chen, Charlene; Wong, Christine; Grosvenor, David; Rose, Jim; Bedenk, Ann; Morrow, Megan; McDermott, Daniel; Hove, Jens D.; Tong, David

doi:10.1016/j.jstrokecerebrovasdis.2016.01.016

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…On the other hand mild stroke patients who taken iv-tPA have low hemorrhage risk and favorable outcomes. The results of the study suggest that the treatment of patients with mild stroke is safe and effective (17).…”

Section: Discussionmentioning

confidence: 82%

Clinical Outcomes of Thrombolytic Therapy in Patients with Mild Stroke: Single-Center Experience in a Tertiary Care Institution

Karadeli

Şimşekoğlu

2021

Preprint

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Objective: The term ‘mild stroke’ is used to describe stroke patients with a NIHSS score of 0 to 6. There is still no clear decision regarding the application of iv recombinant tissue plasminogen activator (iv-tPA) to patients who is admitted with an acute ischemic stroke and is in the mild stroke category. In our study, we aimed to analyze the data of patients who applied to our stroke center with an acute mild stroke clinic and received iv-tPA treatment and their three-month follow-up. Methods: A total of 47 (age 69.1 ± 14.1, 28 female) mild stroke patients were included out of 350 patients receiving thrombolytic therapy. Intravenous thrombolysis was initiated with a maximum delay of 4.5 hours in all patients. Patients had a NIHS score less than 6. NIHSS scores immediately before starting thrombolytic therapy and scores 24 hours after treatment were recorded. Modified Rankin Scale scores (mRS) at admission, 1 and 3 months were recorded. Results: NIHSS scores of the patients who received tPA decreased significantly after the treatment (p = 0.001). The patients’ 1st and 3rd month mRS scores were statistically significantly decreased according to the mRS scores when they entered the treatment (p = 0.001). Conclusions: This study highlights the efficacy of iv-tPA in acute ischemic stroke patients with mild symptoms and demonstrates the low risk profile of this therapy.

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Section: Discussionmentioning

confidence: 82%

Clinical Outcomes of Thrombolytic Therapy in Patients with Mild Stroke: Single-Center Experience in a Tertiary Care Institution

Karadeli

Şimşekoğlu

2021

Preprint

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“…Of the 148 remaining articles, 33 were investigated further and included 20 retrospective studies, 10–29 10 prospective studies, 30–40 and 2 RCTs. 41,42 These studies were conducted in the United States (n = 15), 10,11,16,17,20–22,24,25,27–29,33,35,38,40 Germany (n = 4), 12,30,31,34,41 France (n = 4), 15,32,42 the United Kingdom (n = 3), 13,18,26 Hong Kong (n = 1), 19 Spain (n = 2), 23,37 Italy (n = 1), 36 Austria (n = 1), 14 and Finland (n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…There was also no significant difference reported in terms of 90-day strokerelated mortality among patients treated using the TM model of care or NTM model of care (OR: 1.16, 95% CI: 0.94-1.43, p = 0.17) (Figure 3). Furthermore, although the number of individuals experiencing sICH post-treatment is larger in the TM group in some studies, 12,[20][21][22]24,[27][28][29]33,35,36,42 , this was not sufficient to show a significant difference (OR: 0.99, 95% CI: 0.73-1.34, p = 0.93) (Figure 4). Finally, the rates of thrombolysis and thrombectomy did not significantly differ between the two groups (p = 0.372 and p = 0.508, respectively).…”

Section: Clinical Outcomes Of Studiesmentioning

confidence: 91%

Is telestroke more effective than conventional treatment for acute ischemic stroke? A systematic review and meta-analysis of patient outcomes and thrombolysis rates

Mohamed,

Elsherif,

Legere

et al. 2023

International Journal of Stroke

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Background: Telestroke systems operate through remote communication, providing distant stroke evaluation through expert healthcare providers. The aim of this study was to assess whether the implementation of a telestroke system influenced stroke treatment outcomes in acute ischemic stroke (AIS) patients compared to conventional in-person treatment. Aims: The study group evaluated multiple studies from electronic databases, comparing telemedicine (TM) and non-telemedicine (NTM) AIS patients between 1999 and 2022. aimed to evaluate baseline characteristics, critical treatment times, and clinical outcomes. Summary of review: A total of 12,540 AIS patients were included in our study with 7,936 (63.9%) thrombolyzed patients. Of the thrombolyzed patients, 4,150 (51.7%) were treated with TM while 3,873 (48.3%) were not. Mean age of TM and NTM cohorts were 70.45±4.68 and 70.42±4.63, respectively (p > 0.05). Mean NIHSS scores were comparable, with the TM group reporting a non-significantly higher mean (11.89±3.29.6 vs. 11.13±3.65, p>0.05). No significant difference in outcomes was found for symptoms onset-to- intravenous tissue plasminogen activator times (ivtPA) (144.09±18.87 vs. 147.18±25.97, p=0.632) and door-to-needle times (73.03±20.04 vs. 65.91±25.96, p=0.321). Modified Rankin scale scores (0-2) were evaluated and no significant difference was detected between cohorts (Odds Ratio (OR):1.06, 95% Confidence Interval (CI): 0.89-1.29, p=0.500). Outcomes did not indicate any significance between both cohorts for 90-day mortality (OR: 1.16, 95% CI: 0.94-1.43, p=0.17) or symptomatic intracranial hemorrhage (sICH) (OR: 0.99, 95% CI: 0.73-1.34, p=0.93). Results between groups were also non-significant when analyzing the rate of thrombolysis with ivtPA (30.86%±30.7 vs. 20.5%±18.6, p=0.372) and endovascular mechanical thrombectomy (11.8%±11.7 vs. 18.7%±18.9, p=0.508). Conclusion: Use of telestroke in the treatment of AIS patients is safe with minimal non-significant differences in long-term outcomes and rates of thrombolysis compared to face-to-face treatment. Further studies comparing the different methods of TM are needed to assess the efficacy of TM in stroke treatment.

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“…Consecutive medical records of adults (≥ 18 years) admitted to a hyperacute stroke unit within a metropolitan quaternary hospital in Queensland, Australia, between January 2015 and December 2017 for acute ischaemic stroke treated with ECR and/or thrombolysis were included. To be eligible for thrombolysis, patients had to present within 6 h of symptom onset, and have nil history of intracranial haemorrhage or acute trauma on admission (Balucani et al., 2015; Sørensen et al., 2016). To be eligible for ECR, patients had to present within 24 h of symptom onset, have large vessel occlusion confirmed via computed tomography (CT) or magnetic resonance imaging (MRI) (e.g., basilar artery, middle cerebral artery), generally independent premorbid function, and nil intracerebral haemorrhage (ICH) (Sim et al., 2018; Sørensen et al., 2016).…”

Section: Methodsmentioning

confidence: 99%

“…To be eligible for thrombolysis, patients had to present within 6 h of symptom onset, and have nil history of intracranial haemorrhage or acute trauma on admission (Balucani et al., 2015; Sørensen et al., 2016). To be eligible for ECR, patients had to present within 24 h of symptom onset, have large vessel occlusion confirmed via computed tomography (CT) or magnetic resonance imaging (MRI) (e.g., basilar artery, middle cerebral artery), generally independent premorbid function, and nil intracerebral haemorrhage (ICH) (Sim et al., 2018; Sørensen et al., 2016). Patients who present with an occlusion site not amenable to ECR may receive thrombolysis only.…”

Section: Methodsmentioning

confidence: 99%

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

Minchell

Rumbach

Finch

2021

Intl J Lang & Comm Disor

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Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds What is already known on the subjectStroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper addsDespite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications ...

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Generalized Safety and Efficacy of Simplified Intravenous Thrombolysis Treatment (SMART) Criteria in Acute Ischemic Stroke: The MULTI SMART Study

Cited by 6 publications

References 29 publications

Clinical Outcomes of Thrombolytic Therapy in Patients with Mild Stroke: Single-Center Experience in a Tertiary Care Institution

Clinical Outcomes of Thrombolytic Therapy in Patients with Mild Stroke: Single-Center Experience in a Tertiary Care Institution

Is telestroke more effective than conventional treatment for acute ischemic stroke? A systematic review and meta-analysis of patient outcomes and thrombolysis rates

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

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