Intravenous tissue plasminogen activator in acute branch atheromatous disease: Does it prevent early neurological deterioration?

Park, Min-Gyu; Oh, Eun Hye; Kim, Baik-Kyun; Park, Kyung-Pil

doi:10.1016/j.jocn.2016.04.011

Cited by 19 publications

(34 citation statements)

References 29 publications

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“…Yamamoto et al. 16 prescribed combined antiplatelet therapy for 313 BAD patients treated over 12 years, and found that cilostazol was more effective for those with basilar artery diameters of 200 to 300 μm, whereas clopidogrel was more effective for those with bean-shaped arteries with diameters of 700 to 800 μm. Furthermore, Kimura et al.…”

Section: Discussionmentioning

confidence: 99%

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Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

et al. 2020

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Objectives To investigate the effects of early administration of tirofiban after intravenous thrombolysis on early neurological deterioration in patients with branch atheromatous disease. Methods We analyzed clinical data from patients with branch atheromatous disease. We enrolled seven cases into the urokinase-only (UO) control group and 10 cases into the urokinase + tirofiban (UT) treatment group. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3 and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3 months after admission. Results Significant differences between the UO and UT groups were evident on days 3 and 5 after admission. In the UT group, there was a significant difference between NIHSS scores at admission and on day 5, while there were no significant differences in scores in the UO group. The early neurological deterioration rates were not significantly different between the two groups. However, there were significant differences in these rates at 72 and 120 hours. Both the mRS scores and the prognoses at 3 months differed between the two groups. Conclusion Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration and improves the long-term prognosis of patients with branch atheromatous disease.

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Section: Discussionmentioning

confidence: 99%

“…[13][14][15] A previous study found that intravenous recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy did not improve BADassociated END or BAD prognosis. 16 Therefore, an effective BAD treatment is urgently required.…”

Section: Introductionmentioning

confidence: 99%

Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

et al. 2020

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“…Besides, the severity of initial stroke was measured using NIHSS, which was conducted daily by members of our team. The coprimary outcomes were END, which was defined as an increase of ≥2 points in the NIHSS score within 7 days after stroke ( 3 , 11 ) and favorable outcome at 3 months after stroke, which was defined by a score of 0–1 point on the modified Rankin Scale ( 19 ). Safety variables were death or dependence defined as the mRS score of ≥4 points at 3 months after stroke and the incidence of symptomatic intracranial hemorrhage (sICH) and parenchymal hemorrhage type 2 (PH-2) according to the European Cooperative Acute Stroke Study II (ECASS II), including hemorrhagic infarction classifications HI 1 and HI 2 and parenchymal infarction classifications PH-1 and PH-2 ( 20 ).…”

Section: Methodsmentioning

confidence: 99%

“…Figure 1 shows the flowchart of selection of eligible study subjects. Moreover, as illustrated in Figure 2, BAD-related infarctions were previously defined as follows (6,(11)(12)(13)(14)(15): (1) infarcts with a diameter ≥15 mm that involves ≥3 axial slices on DWI in the blood-supply region of lenticulostriate artery, or lesions extending to the ventral pontine surface in the blood-supply region of paramedian pontine artery; (2) neither evidence of large arterial stenosis (>50%) or occlusion, nor evidence of cardiogenic embolism.…”

Section: Study Subjectsmentioning

confidence: 99%

“…The majority of patients with BAD was classified as minor stroke, while patients with minor stroke typically does not receive IVT. It has been previously reported that IVT neither improves clinical outcome nor prevents END in such patients, while the results of these studies could not be generalized because of their small sample size and lack of control group (11,12). Whether IVT can effectively treat BAD has still remained elusive.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Intravenous Thrombolysis on Acute Branch Atheromatous Disease: A Retrospective Case–Control Study

Wu¹,

Yang²,

Nie³

et al. 2020

Front. Neurol.

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Background and Objective: Branch atheromatous disease (BAD) is distinctive from large-artery atherosclerosis and small-vessel disease, which is single subcortical infarction caused by the occlusion of perforator's orifice. This study aimed to indicate whether intravenous thrombolysis (IVT) with alteplase could prevent early neurological deterioration (END) and improve functional outcome for patients with BAD within 4.5 h after symptom onset. Methods: We retrospectively analyzed data collected from patients with BAD who were admitted to our hospital from January 2015 to August 2019. To investigate the efficacy and safety of IVT, subjects were classified into alteplase and control groups. A propensity score matching analysis was performed to control substantial heterogeneity of subgroup. The coprimary outcomes were END that is defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after stroke, and favorable outcome at 3 months after stroke that defined by a score of 0–1 point on the modified Rankin scale (mRS). Results: A total of 135 patients were eventually enrolled in this study ( n = 51 for the alteplase group and n = 84 for the control group). Additionally, 42 pairs of subjects were successfully matched by propensity score matching. Intravenous alteplase within 4.5 h after stroke onset reduced the incidence of END [unadjusted odds ratio (OR), 3.32; 95% confidence interval (CI), 1.06–10.37] and improved the clinical outcome at 3 months after stroke, with more patients achieving favorable functional prognosis (mRS, 0–1 point; unadjusted OR, 0.25; 95% CI, 0.10–0.62). Patients in the alteplase group were more likely to be independent (mRS, 0–2 points) at 3 months after stroke (unadjusted OR, 0.33; 95% CI, 0.12–0.90). The rate of death or dependence (mRS, ≥4 points) in the alteplase group was also markedly lower than that in the control group (unadjusted OR, 4.06; 95% CI, 1.03–16.02). Conclusion: Our findings indicated that intravenous thrombolysis may be a safe and effective therapy for patients with BAD.

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Predictive factors for early neurological deterioration after intravenous thrombolysis of single subcortical infarction in the territory of the middle cerebral artery

Zhao,

Zhong,

et al. 2023

Brain and Behavior

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IntroductionPatients with a single subcortical infarction (SSI) in the territory of the middle cerebral artery (MCA) often experience early neurological deterioration (END) despite receiving intravenous thrombolytic therapy (IVT). In this study, predictors of END were investigated in patients with SSI in the MCA after IVT.MethodsPatients with SSI in the MCA territory who had received IVT between June 2020 and 2022 were included. END was defined as an increase in the total National Institutes of Health Stroke Scale (NIHSS) score by ≥2 or in the motor NIHSS score by ≥1 within the first 72 h of admission. Patients with proximal (pSSI) and distal SSI (dSSI) were analyzed to determine SSI type‐specific predictors for END.ResultsWe evaluated 174 patients with SSI in the MCA territory who underwent IVT. Multivariable logistic regression analysis showed that pSSI (odds ratio [OR] = 0.242; 95% confidence interval [CI], 0.104–0.564; p = .001), lower high‐density lipoprotein cholesterol (HDL‐C) (OR = 0.150; 95% CI, 0.033–0.682; p = .014), higher blood glucose (OR = 0.858; 95% CI, 0.752–0.979; p = .023), and higher red blood cells count (OR = 1.966; 95% CI, 1.154–3.349; p = .013) were risk factors for END. In patients with pSSI, HDL‐C and blood glucose were associated with END. No variable related to END was found in the dSSI group.ConclusionsThe proportion of END in patients with SSI in the MCA territory after IVT was not low; therefore, pSSI, HDL‐C, blood glucose, and red blood cells should be monitored closely. The frequency and predictors of SSI in the MCA territory differed between pSSI and dSSI.

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Intravenous tissue plasminogen activator in acute branch atheromatous disease: Does it prevent early neurological deterioration?

Cited by 19 publications

References 29 publications

Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

Efficacy and Safety of Intravenous Thrombolysis on Acute Branch Atheromatous Disease: A Retrospective Case–Control Study

Predictive factors for early neurological deterioration after intravenous thrombolysis of single subcortical infarction in the territory of the middle cerebral artery

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