Intravenous thrombolysis in patients with stroke attributable to small artery occlusion

Fluri, Felix; Hatz, Florian; Rutgers, Matthieu; Georgiadis, Dimitrios; Šekoranja, Lučka; Schwegler, Guido; Sarıkaya, Hakan; Weder, Bruno; Müller, Felix; Lüthy, Regina; Arnold, Marcel; Reichhart, Marc; Mattle, Heinrich; Tettenborn, Barbara; Nedeltchev, Krassen; Hungerbühler, H; Sztajzel, Roman; Baumgartner, Ralf W.; Michel, Patrik; Lyrer, P.; Engelter, Stefan T.

doi:10.1111/j.1468-1331.2010.02961.x

Cited by 28 publications

(28 citation statements)

References 29 publications

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“…[21] Favorable outcome in small-vessel disease may be attributed to younger age and milder stroke severity. [22] The occurrence of atheroma and embolism apart from lipohyalinosis alone and perfusion defects on magnetic resonance imaging perfusion scan has been attributed to the beneficiality of thrombolysis in lacunar infarcts. [2324] There is chance of worsening in patients with lacunar infarcts even though they have milder stroke severity.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients

Mehta

Mahale

Buddaraju

et al. 2017

Journal of Neurosciences in Rural Practice

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Background:Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset.Objective:To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h.Materials and Methods:Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015.Results:A total of 97 patients were thrombolysed intravenously. The mean onset to needle time in all patients was 177.2 ± 62 min (range: 60–360). At 3 months follow-up, favorable outcome was seen in 65 patients (67.1%) and poor outcome including death in the remaining 32 patients (32.9%). Factors predicting favorable outcome was age <65 years (P = 0.02), the National Institute of Health Stroke Scale (NIHSS) <15 (P < 0.001), small vessel occlusion (P = 0.006), cardioembolism (P = 0.006), and random blood sugar (RBS) <250 mg/dl (P < 0.001). Factors predicting poor outcome was diabetes mellitus (P = 0.01), dyslipidemia (P = 0.01), NIHSS at admission >15 (P = 0.03), RBS >250 mg/dl (P = 0.01), Dense cerebral artery sign, age, glucose level on admission, onset-to-treatment time, NIHSS on admission score >5 (P = 0.03), and occlusion of large artery (P = 0.02).Conclusion:Milder baseline stroke severity, blood glucose <250 mg/dL, younger patients (<65 years), cardioembolic stroke, and small vessel occlusion benefit from recombinant tissue plasminogen activator.

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Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients

Mehta

Mahale

Buddaraju

et al. 2017

Journal of Neurosciences in Rural Practice

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“…When compared with other stroke mechanisms, lacunar stroke patients died less often (11.2 vs. 1.5%; p = 0.014) and had more favorable functional outcome (mRS scores of 0-2 in 58.9 vs. 75.4%; p = 0.001). This association was no further significant after correction for other possible confounders such as age, gender and baseline NIHSS score [10]. …”

Section: Efficacy Of Thrombolysis In Acute Lacunar Strokementioning

confidence: 99%

“…In a prospective Swiss study, the safety and efficacy of intravenous thrombolysis was analyzed in 65 acute stroke patients of presumed lacunar type [10]. Small artery occlusive disease was defined as the presence of a lacunar syndrome, neuroimaging findings consistent with a small lacunar infarction in the territory of basal or brainstem penetrating arteries, and the absence of stenoocclusive diseases of the parent artery or a cardioembolic disease.…”

Section: Efficacy Of Thrombolysis In Acute Lacunar Strokementioning

confidence: 99%

Thrombolysis in Acute Stroke Patients with Cerebral Small Vessel Disease

2013

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Background: Thrombolytic treatment is of proven benefit in acute ischemic stroke. The term cerebral small vessel disease (SVD) refers to a group of pathological processes affecting the small arteries, arterioles, venules and capillaries of the brain, and encompasses both ischemic and hemorrhagic lesions. Lacunar stroke, an expression of SVD, is associated with an unfavorable long-term prognosis for an increased risk of death, recurrent stroke and cognitive dysfunction. Nonetheless, the efficacy and safety of intravenous thrombolysis in patients with lacunar stroke has been debated for two main reasons. First, among all ischemic stroke subtypes, lacunar strokes have been considered the most benign. Second, the efficacy of a pharmacological reperfusion has been questioned given the absence of a clear demonstration of thrombosis. Intracerebral hemorrhage (ICH) remains the most devastating and unpredictable complication related to thrombolysis, and neuroimaging evidence of SVD is nowadays recognized as one of the risk factors for thrombolysis-related ICH. Summary: This review is structured in two parts dealing with the questions whether or not patients with lacunar stroke or SVD should be treated with thrombolysis. In the first part, we revised the literature concerning the efficacy of thrombolysis in patients with acute lacunar stroke. We included two types of studies: those in which patients with lacunar stroke receiving recombinant human tissue plasminogen activator (rt-PA) were compared with lacunar stroke patients receiving placebo, and those in which a comparison was made among different stroke subtype patients treated with rt-PA. In the second part, we reviewed the available evidence on the risk of ICH in patients treated with thrombolysis for ischemic stroke and presenting with neuroimaging evidence of SVD such as white matter lesions (WML) and cerebral microbleeds. We further questioned the extent to which WML and microbleeds could be used as reliable predictors of ICH and the feasibility of their detection in an acute setting. Key Messages: The studies herein reviewed show that thrombolysis is an effective treatment in acute lacunar stroke, and that the presence of cerebral SVD increases the risk of ICH during thrombolysis but does not represent an absolute exclusion criterion. In the future, it can be assumed that the use of MRI on a routine basis might lead to a better quantitative definition of SVD and its correlates, permitting a step forward in thrombolysis decision making.

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“…Exclusion criteria were the following: the presence of bilateral MCA stroke during the same admission, the presence of an infarction outside of the MCA territory during the same admission, intra-arterial rescue therapy, and incomplete data about the territory of infarction and the modified Rankin score (mRS) at 3 months. Although, among all ischemic stroke subtypes, lacunar strokes have been considered the most benign, this subtype was not excluded because reviewed studies show that thrombolysis is an effective treatment in those cases and the prognosis can be better or without significant trend for better or worse outcome compared with others etiologies 10,14,15,16,17,18 . The ethics committees of both hospitals had previously evaluated and authorized the study.…”

mentioning

confidence: 99%

“…A parenchymal haemorrhage (PH) was defined as a haemorrhage with a space-occupying effect 20,21 . A SHT was defined as brain imaging evidence of HT with clinical worsening, which was indicated by an increase of at least four points in the NIHSS score 15 . The statistical analyses were performed with the Statistica 8.0 software: statistical significance was assessed by either the Student's t-test or the Mann-Whitney's test for continuous variables and the χ 2 -test or Fisher's exact test for categorical variables.…”

mentioning

confidence: 99%

Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?

Ducci

Lange

Moro

et al. 2015

Arq. Neuro-Psiquiatr.

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The impact of the side in middle cerebral artery (MCA) ischemic stroke is not well established. Our aim was to analyze the differences between right (RMCA) and left middle cerebral artery (LMCA) stroke in patients submitted to intravenous thrombolysis and the influence of the affected side in the patient’s mortality after 3 months. Method Patients with MCA ischemic stroke submitted to intravenous thrombolysis from March 2010 to December 2011 at two Brazilian Stroke Centers were included. Differences between patients with RMCA and LMCA stroke were identified by univariate analysis. Results Forty-five patients with RMCA stroke and 67 with LMCA stroke were analyzed. Patients with LMCA had a higher incidence of atrial fibrillation (p = 0.031), although patients with RMCA more often had a previous ischemic stroke (p = 0.034). The mortality over 3 months was similar for either side (OR = 1.20 ;0.37 - 4.29, p = 0.772). Conclusion The side of the MCA ischemic stroke did not influence the patients mortality.

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Intravenous thrombolysis in patients with stroke attributable to small artery occlusion

Cited by 28 publications

References 29 publications

Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients

Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients

Thrombolysis in Acute Stroke Patients with Cerebral Small Vessel Disease

Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?

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