Good Outcome Rate of 35% in IV-tPA–Treated Patients With Computed Tomography Angiography Confirmed Severe Anterior Circulation Occlusive Stroke

Autor: Gordon J. Harris, R. Gilberto Gonzalez, Elkan F. Halpern, Erica C.S. Camargo, Walter J. Koroshetz, William P. Dillon, Wade S. Smith, Gregory V. Goldmacher, Michael H. Lev, Seyedmehdi Payabvash, Shervin Kamalian, Karen L. Furie
Rok vydání: 2013
Předmět:
Male
Cost effectiveness
medicine.medical_treatment
Cardiorespiratory Medicine and Haematology
Modified Rankin Scale
Thrombolytic Therapy
Prospective Studies
Infusions
Intravenous
Prospective cohort study
Tomography
Computed tomography angiography
tissue plasminogen activator
medicine.diagnostic_test
Thrombolysis
Middle Aged
X-Ray Computed
Stroke
Treatment Outcome
Tissue Plasminogen Activator
Biomedical Imaging
Female
Radiology
Intravenous
Cardiology and Cardiovascular Medicine
computed tomography angiography
Cerebral angiography
Brain Infarction
Infusions
thrombolysis
medicine.medical_specialty
Clinical Sciences
Article
Fibrinolytic Agents
Clinical Research
ischemic stroke
medicine
Humans
cardiovascular diseases
Aged
Advanced and Specialized Nursing
Neurology & Neurosurgery
business.industry
Neurosciences
Cerebral Angiography
Brain Disorders
Angiography
Neurology (clinical)
Tomography
X-Ray Computed
business
Fibrinolytic agent
Zdroj: Stroke, vol 44, iss 11
ISSN: 1524-4628
0039-2499
DOI: 10.1161/strokeaha.113.001938
Popis: Background and Purpose— To determine the effect of intravenous tissue plasminogen activator (IV-tPA) on outcomes in patients with severe major anterior circulation ischemic stroke. Methods— Prospectively, 649 patients with acute stroke had admission National Institutes of Health stroke scale (NIHSS) scores, noncontrast computed tomography (CT), CT angiography (CTA), and 6-month outcome assessed using modified Rankin scale. IV-tPA treatment decisions were made before CTA, at the time of noncontrast CT scanning, as per routine clinical protocol. Severe symptoms were defined as NIHSS>10. Poor outcome was defined as modified Rankin scale >2. Major occlusions were identified on CTA. Univariate and multivariate stepwise-forward logistic regression analyses of the full cohort were performed. Results— Of 649 patients, 188 (29%) patients presented with NIHSS>10, and 64 out of 188 (34%) patients received IV-tPA. Admission NIHSS, large artery occlusion, and IV-tPA all independently predicted good outcomes; however, a significant interaction existed between IV-tPA and occlusion ( P 10 with anterior circulation occlusion, twice the percentage had good outcomes if they received IV-tPA (17 out of 49 patients, 35%) than if they did not (13 out of 77 patients, 17%; P =0.031). The number needed to treat was 7 (95% confidence interval, 3–60). Conclusions— IV-tPA treatment resulted in significantly better outcomes in patients with severely symptomatic stroke with major anterior circulation occlusions. The 35% good outcome rate was similar to rates found in endovascular therapy trials. Vascular imaging may help in patient selection and stratification for trials of IV-thrombolytic and endovascular therapies.
Databáze: OpenAIRE
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