Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome

Poggio, Monica Bandettini di; Finocchi, Cinzia; Brizzo, Federica; Altomonte, F; Bovis, Francesca; Mavilio, N.; Serrati, Carlo; Malfatto, Laura; Mancardi, Gianluigi; Balestrino, Maurizio

doi:10.1007/s10072-018-3644-3

Cited by 25 publications

(16 citation statements)

References 24 publications

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“…Our study also showed that a worse collateral perfusion status is associated with the presence of atrial fibrillation, higher baseline NIHSS scores, and greater baseline DWI lesion volumes. Previous studies showed that compared with atherosclerotic occlusions, atrial fibrillation was associated with larger volumes of more severe baseline hypoperfused area and led to worse clinical outcomes, suggesting that this association occurred because abrupt development of acute ischemic stroke led to the less developed collateral circulation (32,33). Collateral studies, including ours, have supported this suggestion (16,34).…”

Section: Discussionsupporting

confidence: 67%

“…However, there is some debate about whether atrial fibrillation is an independent predictor of unfavorable outcomes in acute ischemic stroke. Different study results are attributed to differences in the number of patients who underwent intra-arterial thrombectomy (16,32,33). The effect of less development of collateral circulation in atrial fibrillation on clinical outcomes seems to be masked by the effects of early reperfusion.…”

Section: Discussionmentioning

confidence: 99%

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Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke

Kim¹,

Lee²,

Choi³

et al. 2020

Radiology

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I n cerebral ischemia due to large-vessel occlusion, cell viability depends on the collateral perfusion status (1,2). Infarction might be complete in less than 1 hour or may not be complete for hours or days depending on the collateral perfusion status, which varies among patients (3,4). Therefore, recanalization and reperfusion treatment can be futile or even dangerous when performed in the standard optimal time window, but could be useful if performed in a later time window (5)(6)(7)(8). Studies have shown that a large ischemic core combined with poor collaterals is a strong predictor of an unfavorable response to endovascular treatment and poor functional outcomes. Hence, the exclusion of patients with a large ischemic core and poor collateral circulation could prevent administration of futile and dangerous recanalization therapy. Conversely, good collateral circulation can limit ischemic core expansion and prolong the time the penumbral tissue at risk remains salvageable until reperfusion therapy. Some studies have suggested that the time window for endovascular treatment can be successfully extended in patients with good collaterals (9-14). These results demonstrate the importance of accurately estimating the collateral perfusion status to enable patientspecific application of treatment, thereby improving functional outcomes among patients with acute ischemic stroke due to large-vessel occlusion.Recently, researchers have developed dynamic collateral imaging methods such as multiphase CT angiography and collateral flow maps derived from dynamic susceptibility contrast material-enhanced perfusion MRI (15,16). Studies evaluating these collateral imaging approaches have shown that collateral status is a strong predictor of final infarct size and functional outcomes in patients considered eligible for intra-arterial thrombectomy and intravenous thrombolysis (17,18). For intra-arterial thrombectomy, it

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke

Kim¹,

Lee²,

Choi³

et al. 2020

Radiology

View full text Add to dashboard Cite

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“…Data coming from a greater study that used a more complex parameter termed the stress hyperglycemia ratio but based on fasting glucose and glycated hemoglobin levels also indirectly supported the role of fasting hyper- or normoglycemia as prognostic factors in AIS patients treated with IVT [ 16 ]. In our study, fasting glucose levels influenced long-term outcomes, as did other well-known risk factors such as age and NIHSS score [ 17 ], both on admission and after IVT [ 17 , 18 ]. Interestingly, the lower maximal SBP within 24 h after IVT also independently affected the 3-month favorable outcome after AIS.…”

Section: Discussionmentioning

confidence: 96%

Fasting Normoglycemia after Intravenous Thrombolysis Predicts Favorable Long-Term Outcome in Non-Diabetic Patients with Acute Ischemic Stroke

Wnuk

Derbisz

Drabik

et al. 2021

JCM

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Background: Only a few studies evaluated the role of fasting glucose levels after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Importantly, formal analysis concerning the prognostic role of fasting glucose levels in these patients with and without diabetes mellitus (DM) was not performed. Therefore, we assessed whether fasting normoglycemia (FNG) next morning after AIS treated with IVT was associated with 90-day functional outcome in diabetic and non-diabetic patients. Methods: We retrospectively analyzed 362 AIS patients treated with IVT at The University Hospital in Krakow. FNG was defined as glucose below 5.5 mmol/L. A favorable outcome was defined as modified Rankin score (mRS) of 0–2 at day 90 after AIS onset. Results: At 3-month follow-up, FNG was associated with favorable outcome (87.5% vs. 60.8%, p < 0.001) and decreased risk of death (3.1% vs. 18.1%, p = 0.002). Independent predictors of a favorable outcome for the whole group were: younger age (HR 0.92, 95%CI 0.89–0.95), lower NIHSS score after IVT (HR 0.70, 95%CI 0.65–0.76), lower maximal systolic blood pressure within 24 h after IVT (HR 0.92, 95%CI 0.89–0.95) and FNG (HR 4.12, 95%CI 1.38–12.35). Association between FNG and mortality was found in univariable (HR 1.47, 95%CI 0.04–0.62) but not in multivariable analysis (HR 0.23, 95%CI 0.03–1.81). In subgroup analyses, FNG was an independent predictor of favorable outcome (HR 5.96, 95%CI 1.42–25.1) only in patients without DM. Conclusions: FNG next morning after IVT is an independent protective factor for a favorable long-term outcome in non-diabetic AIS patients.

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“…ASPECTS has been used to accurately predict infarction volume and functional outcomes in patients with AIS receiving endovascular therapy [18,19]. NIHSS has also been validated for selecting candidate patients for IVT treatment [20]. Therefore, we speculate that a more accurate prediction of functional outcome can be achieved by combining the NIHSS score with the imaging results measured by ASPECTS.…”

Section: Discussionmentioning

confidence: 99%

NIHSS–the Alberta Stroke Program Early CT Score mismatch in guiding thrombolysis in patients with acute ischemic stroke

Deng

Chen

et al. 2021

J Neurol

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Objective This study investigates the mismatch between the National Institutes of Health Stroke Scale (NIHSS) score and the computed tomography (CT) findings measured by the Alberta Stroke Program Early CT Score (ASPECTS) for predicting the functional outcome and safety of intravenous thrombolysis (IVT) treatment in patients with acute ischemic stroke (AIS). Methods This prospective observational study includes patients with AIS who underwent CT imaging within 4.5 h of the onset of symptoms. Patients were divided into the NIHSS–ASPECTS mismatch (NAM)-positive and NAM-negative groups (group P and N, respectively). The clinical outcome was assessed using the Modified Rankin Scale (mRS). Safety outcomes included progression, symptomatic intracerebral hemorrhage (sICH), intracerebral hemorrhage (ICH), adverse events, clinical adverse events, and mortality. Results A total of 208 patients were enrolled in the study. In group P, IVT treatment was associated with a good functional outcome at 3 months ( p = 0.005) and 1 year ( p = 0.001). A higher percentage of patients with favorable mRS (0–2) ( p = 0.01) and excellent mRS (0–1) ( p = 0.011) functional outcomes was obtained at 1 year in group P with IVT treatment. Group N did not benefit from the same treatment ( p = 0.352 and p = 0.480 at 3 months and 1 year, respectively). There were no statistically significant differences in sICH, ICH, mortality rates, or other risks between the IVT and conventional treatment groups. Conclusion IVT treatment is associated with a good functional outcome in patients with NAM, without increasing the risks of sICH, ICH, mortality, or other negative outcomes. NAM promises to be an easily obtained indicator for guiding the treatment decisions of AIS.

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Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome

Cited by 25 publications

References 24 publications

Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke

Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke

Fasting Normoglycemia after Intravenous Thrombolysis Predicts Favorable Long-Term Outcome in Non-Diabetic Patients with Acute Ischemic Stroke

NIHSS–the Alberta Stroke Program Early CT Score mismatch in guiding thrombolysis in patients with acute ischemic stroke

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