Impact Of Intravenous Thrombolysis Research Articles

Neutrophil activation in patients treated with endovascular therapy is associated with unfavorable outcomes and mitigated by intravenous thrombolysis

BackgroundAccumulating evidence indicates that neutrophil activation (NA) contributes to microvascular thromboinflammation in acute ischemic stroke (AIS) due to a large vessel occlusion. Preclinical data have suggested that intravenous thrombolysis (IVT)...

Abstract P480: Impact of Intravenous Thrombolysis on Reperfusion Status in Stroke Thrombectomy

Introduction: It remains unclear whether use of intravenous thrombolysis (IVT) with intravenous tissue plasminogen activator (tPA) provides additional benefit to patients with emergent large vessel occlusion (ELVO) stroke undergoing mechanical thrombectomy (MT). We sought to determine the impact of IVT on procedure time, number of passes, and successful reperfusion (SR) during MT. Method: We retrospectively analyzed all patients who underwent anterior circulation mechanical thrombectomy for treatment of ELVO stroke at our institution from April 2012 to November 2019. Univariate and multivariate logistic regression analyzes were used to determine independent predictors of poor functional outcome at 90 days,and independent predictors of >2 thrombectomy passes in patients with successful revascularization (SR: TICI 2B, 2C and 3). Results: A total of 400 patients were eligible for analysis. 189 patients received IVT before thrombectomy. Last known well time-to-endovascular therapy was shorter in the IVT group (290.0 min vs 452.75 min; P=<0.001). The IVT group had a trend towards better outcomes at 90 days (mRS 0—2: 44% vs 35%; P=0.076). The number of passes and revascularization status did not significantly differ between IVT and non-IVT patients. The number of patients with any intracranial hemorrhage was higher in the IVT group than non- IVT group [10% vs 4%; p=0.038].Multivariate logistic regression demonstrated ICA occlusion site was an independent predictors of >2 passes relative to M1 occlusion in patients with successful revascularization. Multivariate logistic regression revealed that age (OR 1.05, 95% CI 1.03-1.07; p<0.001), NIHSS (OR 1.11, 95% CI 1.06-1.17; p<0.001), ≥3 thrombectomy passes (OR 2.47, 95% CI 1.23-5.00; p=0.011) and intracranial hemorrhage (OR 5.50, 95% CI 1.45-20.84; p=0.012)were independently associated with an increased odds of poor outcome. TICI 2C/3 was associated with reduced odds of poor outcome (OR 0.16, 95% CI 0.07-0.35; p<0,001). Conclusion: IVT pretreatment did not increase rates of SR and did not shorten MT procedure time nor number of passes needed to achieve SR during MT in our patient population. Randomized controlled trials are required for further evaluation of the impact of IVT on reperfusion status during MT.

The impact of intravenous thrombolysis in acute ischemic stroke in National Medical College, Kolkata: initial experience

Background: Acute ischemic stroke is a potentially treatable condition, if left untreated, lead to mortality and morbidity. This study was conducted to study clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (r-TPA-alteplase) and to measure the outcome of thrombolysis.Methods: Retrospective observational study of 54 patients who underwent thrombolysis for acute ischemic stroke at National Medical College, Kolkata over a period of one year.Results: There was statistically significant improvement in NIHSS (p value-0.000) after intravenous thrombolysis.Conclusions: IV thrombolysis is feasible for AIS in governmental hospital in India.

Impact of intravenous thrombolysis on functional outcome in patients with mild ischemic stroke without large vessel occlusion or rapidly improving symptoms.

Optimal treatment strategy in patients with mild ischemic stroke remains uncertain. While functional dependency or death has been reported in up to one-third of non-thrombolyzed mild ischemic stroke patients, intravenous thrombolysis is currently not recommended in this patient group. Emerging evidence suggests two risk factors-rapid early improvement and large vessel occlusion-as main associates of unfavorable outcome in mild ischemic stroke patients not undergoing intravenous thrombolysis. To analyze natural course as well as safety and three-month outcome of intravenous thrombolysis in mild ischemic stroke without rapid early improvement or large vessel occlusion. Mild ischemic stroke was defined by a National Institute of Health Stroke Scale score ≤6. We used the modified Rankin Scale (mRS) to compare three-month functional outcome in 370 consecutive mild ischemic stroke patients without early rapid improvement and without large vessel occlusion, who either underwent intravenous thrombolysis (n = 108) or received best medical treatment (n = 262). Favorable outcome (mRS ≤ 1) was common in both groups (intravenous thrombolysis: 91%; no intravenous thrombolysis: 90%). Although intravenous thrombolysis use was independently associated with a higher risk of asymptomatic hemorrhagic transformation (OR = 4.62, p = 0.002), intravenous thrombolysis appeared as an independent predictor of mRS = 0 at three months (OR = 3.33, p < 0.0001). Mild ischemic stroke patients without rapidly improving symptoms and without large vessel occlusion have a high chance of favorable three-month outcome, irrespective of treatment type. Patients receiving intravenous thrombolysis, however, more often achieved complete remission of symptoms, which particularly in mild ischemic stroke may constitute a meaningful endpoint.

Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis.

Tandem anterior circulation lesions in the setting of acute ischemic stroke (AIS) are a complex endovascular situation that has not been specifically addressed in trials. We determined the predictors of successful reperfusion and good clinical outcome at 90 days after mechanical thrombectomy (MT) in patients with AIS with tandem lesions in a pooled collaborative study. This was a retrospective analysis of consecutive patients presenting to 18 comprehensive stroke centers with AIS due to tandem lesion of the anterior circulation who underwent MT. A total of 395 patients were included. Successful reperfusion (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 76.7%. At 90 days, 52.2% achieved a good outcome (modified Rankin Scale score 0-2), 13.8% suffered a parenchymal hematoma and 13.2% were dead. Lower National Institutes of Health Stroke Scale score [odds ratio (OR), 1.26; 95% confidence intervals (CI), 1.07-1.48, P = 0.004], Alberta Stroke Program Early CT Score ≥7 (OR, 2.00; 95% CI, 1.07-3.43, P = 0.011), intravenous thrombolysis (OR, 1.47; 95% CI, 1.01-2.12, P = 0.042) and stenting of the extracranial carotid lesion (OR, 1.63; 95% CI, 1.04-2;53, P = 0.030) were independently associated with successful reperfusion. Lower age (OR, 1.58; 95% CI, 1.26-1.97, P < 0.001), absence of hypercholesterolemia (OR, 1.77; 95% CI, 1.10-2.84, P = 0.018), lower National Institutes of Health Stroke Scale scores (OR, 2.04; 95% CI, 1.53-2.72, P < 0.001), Alberta Stroke Program Early CT Score ≥7 (OR, 2.75; 95% CI, 1.24-6.10, P = 0.013) and proximal middle cerebral artery occlusion (OR, 1.59; 95% CI, 1.03-2.44, P = 0.035) independently predicted a good 90-day outcome. Intravenous thrombolysis and emergent stenting of the extracranial carotid lesion were predictors of a successful reperfusion after MT of patients with AIS with tandem lesion of the anterior circulation.

Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke.

BackgroundThere are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods.Materials and methodsWe retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS.ResultsWe included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67–75) years and the median LOS was 5 (4–7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4–13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI] =1.15 [range 1.01–1.30], P=0.040), severe stroke (IRR [95% CI] =1.27 [1.09–1.47], P=0.002), thrombolytic use (IRR [95% CI] =0.68 [0.60–0.76], P<0.001), and atrial fibrillation (IRR [95% CI] =1.15 [1.02–1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI] =0.74 [0.67–0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI] =1.14 [1.02–1.28], P=0.018), pneumonia (IRR [95% CI] =1.48 [1.30–1.68], P<0.001), and urinary tract infection (IRR [95% CI] =1.41 [1.14–1.74], P=0.001).ConclusionAccording to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications.

Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy.

Randomized controlled trials have shown that bridging endovascular therapy (EVT) after intravenous thrombolysis (IVT) therapy improves outcome in patients with stroke with large-artery anterior circulation stroke compared with IVT alone. It remains unknown whether IVT adds any benefit to EVT in these patients. The aim of this study was to assess recanalization rates and thrombus dislocation before initiation of EVT in patients receiving bridging therapy. All patients in the Bernese stroke registry (2008-2015) in whom bridging therapy was considered were included in this analysis. Relevant recanalization before EVT, thrombus dislocation and increase in thrombus load between initial and control imaging were assessed retrospectively. A total of 319 patients were included. Relevant recanalization before EVT occurred in 8.8% and thrombus dislocation in 7.2% of patients before EVT. Recanalization rates were significantly higher in distal compared with large and more proximal vessel occlusions of the anterior circulation (occlusion of internal carotid artery, 5.4%; middle cerebral artery segment M1, 8.1%; middle cerebral artery segment M2, 17.6%) and in drip-and-ship patients compared with mother-ship patients. In multivariable regression analysis the occlusion site was the only independent predictor of relevant recanalization before EVT (P=0.046). Relevant recanalization after IVT and prior to EVT in patients receiving bridging therapy was highly dependent on the occlusion site. These findings suggest that future randomized controlled trials should consider occlusion site and treatment paradigm to specify patients who benefit most from bridging therapy in comparison to EVT or IVT alone.

The impact of intravenous thrombolysis on outcome of patients with acute ischemic stroke after 90 years old

BackgroundAge increases the risk of mortality and poor prognosis following stroke. The benefit of intravenous thrombolysis in very old patients remains uncertain. The purpose of the study was to evaluate the efficacy and safety of thrombolysis in very old patients considering their perfusion-imaging profile.MethodsWe conducted a retrospective study including patients older than 90 y.o. admitted for an acute ischemic stroke. A computed tomography perfusion-imaging (CTP) was performed in patients who received thrombolysis. Primary outcome was the functional status at 3 months, assessed by the modified Rankin scale (mRS). Secondary outcomes were the rate of hemorrhagic transformations, duration of hospitalization and the rate of death in the first 7 days. Patients receiving thrombolysis were compared with an age-matched group of non-thrombolysed patients.Results78 patients were included (31 % male, aged 92 ± 1.7 y.o). 37 patients received thrombolysis and among them, 30 had CTP with a mismatch. The three months mRS was not significantly different in the two groups (mRS 0–2: 5 % and 7 % in the thrombolysed and non-thrombolysed group, respectively). Hemorrhagic transformations were more frequent in the thrombolysed group (54 % versus 12 %, p = 0.002) and symptomatic intracranial hemorrhage tended to be associated with mRS at three months and death in the first 7 days. Duration of hospitalization was longer in the thrombolysed group (10 days ± 12 versus 7 days ± 9, p = 0.046).ConclusionsPatients who received thrombolysis did not have a better functional prognosis than non-thrombolysed patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0331-1) contains supplementary material, which is available to authorized users.

Intravenous Thrombolysis and Coronary Revascularization Rates

To the Editor.— The impact of intravenous thrombolysis on the rates of short-term interventional procedures (cardiac catheterization, angioplasty, and bypass surgery) was addressed recently by Naylor and Jaglal 1 and, in an accompanying editorial, by Schlant. 2 They explained the paradoxic increase in revascularization procedures (angioplasty and bypass surgery) on the basis that, although thrombolysis takes care of the offending occlusive thrombus, there remains the significant underlying atherosclerotic plaque, which may or may not rerupture to cause post-infarction angina or sudden ischemic death. But neither article offered to explain why the number of revascularization procedures was higher in patients treated with tissue plasminogen activator than in the streptokinase-treated patients. 1 In the current controversy concerning whether tissue plasminogen activator is superior to streptokinase as a thrombolytic agent, 3 this finding by Naylor and Jaglal simply adds more fuel to the fire. Finally, instead of the answer Only if we have

Impact of Intravenous Thrombolysis on Short-term Coronary Revascularization Rates

Evidence of the potential impact of intravenous thrombolytic therapy on short-term revascularization rates among patients with acute myocardial infarction was sought. Because nonrandomized comparisons with conventional treatment would be subject to various confounders, a meta-analysis of randomized controlled trials was performed. Seven trials were included, applying standard doses of either tissue plasminogen activator or streptokinase without an aggressive revascularization protocol. Follow-up ranged from 14 to 30 days. The revascularization rates among treated patients in all trials were lower than in the conservative arm of the Thrombolysis in Myocardial Infarction Phase II trial, which established the current procedural benchmarks for postthrombolysis management. However, the aggregate volume of bypass surgery and angioplasty in patients treated with tissue plasminogen activator was more than double that of controls (odds ratio, 2.25; 95% confidence interval, 1.31 to 3.94), with a smaller but still significant increase for streptokinase-treated patients (odds ratio, 1.66; 95% confidence interval, 1.08 to 2.59). Combining all trials, the increase in mechanical revascularization was 80% (95% confidence interval, 33% to 144%). Thus, for patterns of practice currently accepted in North America, intravenous thrombolysis for myocardial infarction leads to a significant short-term increase in clinical and angiographic indications for revascularization as compared with conventional treatment.

Impact of intravenous thrombolysis on short-term coronary revascularization rates. A meta-analysis

Impact of intravenous thrombolysis on short-term coronary revascularization rates. A meta-analysis