Should IV Thrombolysis be given in Patients with Suspected Ischemic Stroke but Unknown Symptom Onset and Without Diffusion-Weighted Imaging Lesion? – Results of a Case-Control Study

Seyhan, Mert; Mackenrodt, Daniel; Gunreben, Ignaz; Müllges, Wolfgang; Hæusler, Karl Georg; Pham, Mirko; Kleinschnitz, Christoph; Kraft, Peter

doi:10.1016/j.jstrokecerebrovasdis.2019.104515

Cited by 4 publications

(10 citation statements)

References 16 publications

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“…In accordance with previous studies [ 4 , 8 , 9 , 15 , 16 ], this study showed that 12.36% of the patients that received IV tPA within 4.5 hours had negative DWI imaging. However, the rate of negative DWI imaging was lower than that of another study [ 17 ] (29%) with lower admission NIHSS score, enrollment of TIA, and different imaging parameters discussed later.…”

Section: Discussionsupporting

confidence: 92%

“…However, stroke may also be due to milder ischemic tissue changes including cerebral oligaemia or cerebral blood flow reduction tended to be invisible on DWI imaging. Cerebral oligaemia or cerebral blood flow reduction was not as severe as cytotoxic edema and manifested as minor ischemic symptoms and lower NIHSS score [ 8 , 21 ]. Perfusion imaging could help to quantify the severity of the ischemic lesion.…”

Section: Discussionmentioning

confidence: 99%

“…It remains unclear whether DWI-negative stroke would be associated with different clinical prognoses compared with DWI-positive stroke patients. A case-control study with a small sample size ( n = 43) found better functional outcome at discharge for DWI-positive patients compared with DWI-negative patients [ 8 ]. A retrospective study enrolled 89 patients treated with IV tPA within 4.5 hours and found that negative DWI imaging would not increase the risk of symptomatic or asymptomatic cerebral hemorrhage [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…A retrospective study enrolled 89 patients treated with IV tPA within 4.5 hours and found that negative DWI imaging would not increase the risk of symptomatic or asymptomatic cerebral hemorrhage [ 9 ]. However, insufficient sample size reduced the validation and generalization of the results from the previous studies [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis

Feng

Wang

et al. 2022

BMC Neurol

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Objective We aimed to investigate whether negative diffusion weighted imaging (DWI) is related to the in-hospital clinical outcomes for ischemic stroke patients with intravenous tissues plasminogen activator (IV tPA). Methods We retrospectively enrolled patients who received IV tPA therapy within 4.5 hours from symptoms onset. The classification of DWI-positive or negative was based on post-IV tPA MR scan. Demographic factors, stroke characteristics, imaging information, and the in-hospital clinical outcomes including early neurological improvement (ENI) and favourable functional outcome were collected. Multivariable logistic regression and sensitivity analyses were conducted to test whether negative DWI imaging was an independent predictor of the in-hospital clinical outcomes. Results In the final study population, 437 patients treated with IV tPA were included and 12.36% of them had negative DWI imaging at the first MR scan post IV tPA. In the DWI-negative group, 51.9% (28/54) of the patients achieved ENI at 24 hours and 74.1% (40/54) of the patients achieved favourable clinical outcome at discharge. DWI-negative was not related to ENI (adjusted odds ratio 0.93, 95% confidence interval 0.17–4.91) or favourable clinical outcome (adjusted odds ratio 2.40, 95% confidence interval 0.48–11.95). Additional sensitivity analyses yielded similar results. Conclusion DWI-negative is not associated with ENI or favourable functional outcome at discharge.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis

Feng

Wang

et al. 2022

BMC Neurol

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“…Oxidative stress is the basic pathological mechanism of ischemic brain injury and reperfusion injury. The accumulation of reactive oxygen species in stroke area and ischemic penumbra (that is, the surrounding area of infarction) can lead to the damage of cell membrane, DNA, and polypeptides, as well as the destruction of redox balance of various biochemical systems [ 6 ]. Meanwhile, in the acute phase of stroke, the peripheral blood vessels of the body can release a large number of reactive oxygen species and proinflammatory factors, further aggravating the injury of vascular endothelium [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance and Value of Serum Homocysteine and Urine 11 Dehydrothromboxane B2 Combined with Transferrin-Specific Peptide in the Diagnosis of Cerebral Apoplexy

Zhang

2022

Computational and Mathematical Methods in Medicine

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Objective. To explore the clinical significance and value of serum homocysteine (Hcy) and urine 11 dehydrothromboxane B2 (urine 11-DH-TXB2) combined with transferrin-specific peptide (TF-UP) in the diagnosis of stroke. Methods. One hundred stroke patients treated from January 2019 to June 2021 were enrolled in our hospital as the study group. All the patients in the study group met the diagnostic criteria of stroke. The focus of stroke was confirmed by CT or MRI, and the first onset was less than 48 hours. One hundred healthy persons who went through physical examination in our hospital were enrolled as the control group. The comparison was taken to explore the clinical significance and value of Hcy and urine 11-DH-TXB2 combined with TF-UP in the diagnosis of stroke. Results. There exhibited no significant difference in the history of smoking, drinking, and atrial fibrillation ( P > 0.05 ). There were significant differences in systolic blood pressure, diastolic blood pressure, eGFR, history of hypertension, diabetes, and coronary heart disease ( P < 0.05 ). In terms of the levels of Hcy, urine 11-DH-TXB2, and TF-UP, the levels of Hcy and urine 11-DH-TXB2 in the study group were higher compared to the control group, while the level of TF-UP in the study group was lower compared to the control group ( P < 0.05 ). The results of logistic regression analysis indicated that there was a significant correlation between Hcy, urine 11-DH-TXB2, TF-UP, and stroke, and Hcy and urine 11-DH-TXB2 indicated positive correlation with stroke disease, while TF-UP level was negatively correlated with stroke disease ( P < 0.05 ). The levels of Hcy, urine 11-DH-TXB2, and TF-UP were adopted as evaluation indexes to draw ROC curve. The results show that the area under the curve (AUC) of Hcy is 0.760 (95% CI 0.670~0.850). The best critical point was 3342.5 pg/mg Ucr, the sensitivity was 65.6%, and the specificity was 77.1%. The AUC of urine 11-DH-TXB2 was 0.773 (95% CI 0.685~0.861). The best critical point was 3354.44 pg/mg Ucr, the sensitivity was 71.2%, and the specificity was 78.3%. The AUC of TF-UP was 0.735 (95% CI 0.641~0.829). The best critical point was 3365.43 pg/mg Ucr, the sensitivity was 68.4%, and the specificity was 80.5%. If Hcy was detected in combination with other indexes, AUC increased to 0.749 when combined with urine 11-DH-TXB2, and AUC increased to 0.797 when combined with TF-UP. When the three are combined, the AUC can reach 0.836, the sensitivity is 79.1%, and the specificity is 80%. It shows that the combined detection of Hcy, urine 11-DH-TXB2, and TF-UP is of higher diagnostic value. The difference of data exhibited statistically significant ( P < 0.05 ). Conclusion. There is imbalance between Hcy, urine 11-DH-TXB2, and TF-UP in patients with acute stroke. High Hcy, urine 11-DH-TXB2, and low TF-UP are closely related to the occurrence of cerebral infarction. Hcy, urine 11-DH-TXB2, and TF-UP may be the risk factors of stroke and positively correlated with the degree of neurological impairment. Effective monitoring of Hcy and urine 11-DH-TXB2 combined with TF-UP levels and positive intervention measures may effectively prevent the occurrence and development of cerebral infarction, reduce Hcy and urine 11-DH-TXB2, or increase the level of TF-UP, which may provide new ideas for the treatment of cerebrovascular diseases.

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Wake-up stroke: imaging-based diagnosis and recanalization therapy

Zhang

Wang

et al. 2020

J Neurol

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Should IV Thrombolysis be given in Patients with Suspected Ischemic Stroke but Unknown Symptom Onset and Without Diffusion-Weighted Imaging Lesion? – Results of a Case-Control Study

Cited by 4 publications

References 16 publications

In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis

In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis

Clinical Significance and Value of Serum Homocysteine and Urine 11 Dehydrothromboxane B2 Combined with Transferrin-Specific Peptide in the Diagnosis of Cerebral Apoplexy

Wake-up stroke: imaging-based diagnosis and recanalization therapy

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