Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population

Abstract

for the QABE investigatorsBackground and Purpose-Thrombolysis improves outcome of patients with acute ischemic stroke, but it is unknown whether thrombolysis has a measurable effect on long-term outcome in a defined population. Methods-We prospectively assessed demographic data, management, and outcome of acute ischemic stroke patients admitted within 48 hours to 18 primary care hospitals of the canton of Bern (969 299 inhabitants) during 12 months. Blinded follow-up was obtained at 3 and 12 months. Predictors of mortality and favorable outcome (modified Rankin Scale score Յ2) at 3 and 12 months using logistic regression were analyzed. Results-From December 2007 to December 2008, 807 patients (mean age, 72 years) were included. Median NationalInstitutes of Health Stroke Scale score on admission was 5; 107 patients (13%) received intravenous, intra-arterial, or mechanical thrombolysis. Estimated cumulative mortality at 3 months was 20.6% and at 12 months 27.4%. Age 75 years or older, higher National Institutes of Health Stroke Scale scores, and higher Charlson comorbidity index were independent predictors of mortality at 3 and 12 months. Estimated favorable outcome at 3 months was 48.2% and at 12 months was 44.6%. Thrombolysis was the only modifiable independent predictor of favorable outcome at 3 (relative risk, 1.49; 95% CI, 1.18 -1.89) and 12 months (relative risk, 1.59; 95% CI, 1.24 -2.04), whereas age younger than 75 years, male gender, National Institutes of Health Stroke Scale score Ͻ4, and lower Charlson comorbidity index were nonmodifiable predictors. Conclusions-Thirteen percent of acute ischemic stroke patients admitted within 48 hours to Bernese hospitals underwent thrombolysis, which exerted a measurable effect on 3-month outcome in this population. This effect was sustained at 12 months. Age, stroke severity, Charlson comorbidity index, and male gender were independent nonmodifiable predictors of outcome.

Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

“…Classically, NIHSS has been described as an independent predictor of clinical improvement after recanalization therapies [11][12][13] and a long term clinical outcome predictor [14]. In previous studies, NIHSS values have consistently been demonstrated to be lower in DR patients, [2,4,5] and clinical severity in our study population was similar to these studies.…”

The Cost of Materials for Intra-Arterial Thrombectomy

“…In ten (17.5%) patients, no 26,27 . Consequently, as the cost-effectiveness of the initial treatment 2,20,21 and PSC for acute stroke care has been reported, it would be logical to invest money in the first steps of the curative treatment, which remains challenging when financial resources may be lacking 28 .…”

One-Year MR Angiographic and Clinical Follow-Up after Intracranial Mechanical Thrombectomy Using a Stent Retriever Device

“…Moreover, considering the patients in this study as a whole, we observed further significant clinical improvement between 3-month and 1-year FU, whereas natural stroke history without treatment suggests stable clinical outcome over time. 19 This suggests that clinical evaluation would be more appropriate at 1 or 2 years rather than at 3 months.…”