Abstract
ObjectivesCerebral reperfusion therapy is recommended for the treatment of acute ischemic stroke. However, the outcomes of patients receiving this therapy in middle- and low-income countries should be better defined. This study aimed to evaluate the clinical and functional outcomes of cerebral reperfusion therapy in patients with ischemic stroke.Materials and MethodsThis retrospective study included patients with ischemic stroke treated with cerebral reperfusion therapy, including intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and IVT with MT. The primary outcomes were death and disability, assessed using the modified Rankin scale (mRS), and stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS), after intervention and 90 days after ictus. The association between the type of treatment and the primary outcome was assessed using binary logistic regression after adjusting for confounding variables. Furthermore, receiver operating characteristic (ROC) curves were generated to identify the cutoff point of the NIHSS score that could best discriminate the mRS score in all types of treatments.ResultsPatients (n = 291) underwent IVT only (n = 241), MT (n = 21), or IVT with MT (n = 29). In the IVT with MT group, the incidence of death within 90 days increased by five times (OR, 5.192; 95% CI, 2.069–13.027; p = 0.000), prevalence of disability increased by three times (OR, 3.530; 95% CI, 1.376–9.055; p = 0.009) and NIHSS score increased after IVT (from 14.4 ± 6.85 to 17.8 ± 6.36; p = 0.045). There was no significant difference between the initial NIHSS score and that after MT (p = 0.989). Patients' NIHSS score that increased or decreased by 2.5 points had a sensitivity of 0.74 and specificity of 0.65, indicating severe disability or death in these patients.ConclusionAltogether, a 2.5-point variation in NIHSS score after reperfusion is an indicator of worse outcomes. In our particular context, patients receiving the combination of IVT and MT had inferior results, which probably reflects challenges to optimize MT in LMIC.
Highlights
Cerebral reperfusion therapy is indicated for ischemic strokes, which account for 80% of all strokes [1]
There was no significant difference between the initial National Institutes of Health Stroke Scale Score (NIHSS) score and that after mechanical thrombectomy (MT) (p = 0.989)
The study demonstrated that IVT with MT increased the risk of death and disability in patients within 90 days after ictus compared with others groups (IVT and MT alone), there were differences in the clinical features at onset between the groups that received treatment with IV thrombolysis, mechanical thrombectomy, and those that received both treatments
Summary
Cerebral reperfusion therapy is indicated for ischemic strokes, which account for 80% of all strokes [1]. Interventions should be administered at an optimal time to minimize damage to the central nervous system and increase the chance of better outcomes [2, 3]. Recanalization is possibly the main factor for favorable outcomes after ischemic stroke; rapid and effective recanalization increases the chance of better clinical and neurological outcomes [4]. The advantages of combined therapy with intravenous (IV) t-PA with other modalities of cerebral reperfusion, such as intra-arterial recanalization, are being evaluated. This type of combination strategy has shown good long-term prognosis in previous studies [12, 13]. The therapeutic window of MT can be extended to up to 8 h after the onset of stroke symptoms in conjunction with standard care, resulting in better functional outcomes at 90 days after stroke than standard care alone [16]
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