Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
06 Oct 2023
06 Oct 2023
Historique:
revised:
29
09
2023
received:
20
02
2023
accepted:
30
09
2023
pubmed:
6
10
2023
medline:
6
10
2023
entrez:
6
10
2023
Statut:
aheadofprint
Résumé
This study was undertaken to examine averted stroke in optimized stroke systems. This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13-2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12-2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution. In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2023.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Patient-Centered Outcomes Research Institute
ID : R-1511-33024
Pays : United States
Informations de copyright
© 2023 American Neurological Association.
Références
Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke Statistics-2021 update: a report from the American Heart Association. Circulation 2021;143:e254-e743.
Campbell BCV, De Silva DA, Macleod MR, et al. Ischaemic stroke. Nat Rev Dis Primers 2019;5:70.
Jones TH, Morawetz RB, Crowell RM, et al. Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 1981;54:773-782.
Markus HS. Cerebral perfusion and stroke. J Neurol Neurosurg Psychiatry 2004;75:353-361.
Yoo J, Choi JW, Lee SJ, et al. Ischemic diffusion lesion reversal after endovascular treatment. Stroke 2019;50:1504-1509.
Tsai JP, Mlynash M, Christensen S, et al. Time from imaging to endovascular reperfusion predicts outcome in acute stroke. Stroke 2018;49:952-957.
Rao V, Christensen S, Yennu A, et al. Ischemic core and hypoperfusion volumes correlate with infarct size 24 hours after randomization in DEFUSE 3. Stroke 2019;50:626-631.
A classification and outline of cerebrovascular diseases. II. Stroke 1975;6:564-616.
Easton JD, Johnston SC. Time to retire the concept of transient ischemic attack. JAMA 2022;327:813-814.
Kassem-Moussa H, Graffagnino C. Nonocclusion and spontaneous recanalization rates in acute ischemic stroke: a review of cerebral angiography studies. Arch Neurol 2002;59:1870-1873.
Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014;384:1929-1935.
Fonarow GC, Zhao X, Smith EE, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014;311:1632-1640.
Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010;375:1695-1703.
Kim JT, Fonarow GC, Smith EE, et al. Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5-hour time-benefit curve in the National United States get with the Guidelines-Stroke Population. Circulation 2017;135:128-139.
Spokoyny I, Raman R, Ernstrom K, et al. Imaging negative stroke: diagnoses and outcomes in intravenous tissue plasminogen activator-treated patients. J Stroke Cerebrovasc Dis 2014;23:1046-1050.
Chernyshev OY, Martin-Schild S, Albright KC, et al. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology 2010;74:1340-1345.
Freeman JW, Luby M, Merino JG, et al. Negative diffusion-weighted imaging after intravenous tissue-type plasminogen activator is rare and unlikely to indicate averted infarction. Stroke 2013;44:1629-1634.
Navi BB, Audebert HJ, Alexandrov AW, et al. Mobile stroke units: evidence, gaps, and next steps. Stroke 2022;53:2103-2113.
Grotta JC, Yamal JM, Parker SA, et al. Prospective, multicenter, controlled trial of mobile stroke units. N Engl J Med 2021;385:971-981.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993;24:35-41.
Uchino K, Massaro L, Hammer MD. Transient ischemic attack after tissue plasminogen activator: aborted stroke or unnecessary stroke therapy? Cerebrovasc Dis 2010;29:57-61.
Nagaraja N, Forder JR, Warach S, Merino JG. Reversible diffusion-weighted imaging lesions in acute ischemic stroke: a systematic review. Neurology 2020;94:571-587.
The NINDS rt-PA Stroke Study Group. The NINDS rt-PA stroke study archived clinical research dataset. Available at: https://www.ninds.nih.gov/current-research/research-funded-ninds/clinical-research/archived-clinical-research-datasets. Accessed May 10, 2023.
Rocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke: clinical and research implications. Stroke 2017;48:2621-2627.