TY - JOUR
TI - Intravenous thrombolysis for large vessel or distal occlusions presenting with mild stroke severity
AU - Tsivgoulis, G.
AU - Goyal, N.
AU - Katsanos, A.H.
AU - Malhotra, K.
AU - Ishfaq, M.F.
AU - Pandhi, A.
AU - Frohler, M.T.
AU - Spiotta, A.M.
AU - Anadani, M.
AU - Psychogios, M.
AU - Maus, V.
AU - Siddiqui, A.
AU - Waqas, M.
AU - Schellinger, P.D.
AU - Groen, M.
AU - Krogias, C.
AU - Richter, D.
AU - Saqqur, M.
AU - Garcia-Bermejo, P.
AU - Mokin, M.
AU - Leker, R.
AU - Cohen, J.E.
AU - Magoufis, G.
AU - Psychogios, K.
AU - Lioutas, V.A.
AU - Van Nostrand, M.
AU - Sharma, V.K.
AU - Paciaroni, M.
AU - Rentzos, A.
AU - Shoirah, H.
AU - Mocco, J.
AU - Nickele, C.
AU - Mitsias, P.D.
AU - Inoa, V.
AU - Hoit, D.
AU - Elijovich, L.
AU - Arthur, A.S.
AU - Alexandrov, A.V.
JO - European Journal of Paediatric Neurology
PY - 2020
VL - 27
TODO - 6
SP - 1039-1047
PB - Wiley-Blackwell Publishing Ltd
SN - 1090-3798
TODO - 10.1111/ene.14199
TODO - anticoagulant agent;  tissue plasminogen activator, adult;  all cause mortality;  anterior cerebral artery;  Article;  blood clot lysis;  brain hemorrhage;  brain ischemia;  computer assisted tomography;  controlled study;  coronary artery disease;  diabetes mellitus;  diastolic blood pressure;  disease severity;  drug efficacy;  drug safety;  edema;  female;  fibrinolytic therapy;  follow up;  functional assessment;  Functional Independence Measure;  hospital admission;  hospital discharge;  human;  internal carotid artery;  magnetic resonance angiography;  major clinical study;  male;  mechanical thrombectomy;  middle aged;  middle cerebral artery;  multicenter study;  National Institutes of Health Stroke Scale;  neurologic disease;  occlusive cerebrovascular disease;  post hoc analysis;  posterior cerebral artery;  priority journal;  Rankin scale;  recanalization;  sensitivity analysis;  systolic blood pressure
TODO - Background and purpose: We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS) patients with large vessel or distal occlusions and mild neurological deficits, defined as National Institutes of Health Stroke Scale scores < 6 points. Methods: The primary efficacy outcome was 3-month functional independence (FI) [modified Rankin Scale (mRS) scores 0–2] that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included 3-month favorable functional outcome (mRS scores 0–1) and mRS score distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding. Results: We evaluated 336 AIS patients with large vessel or distal occlusions and mild stroke severity (mean age 63 ± 15 years, 45% women). Patients treated with IVT (n = 162) had higher FI (85.6% vs. 74.8%, P = 0.027) with lower mRS scores at hospital discharge (P = 0.034) compared with the remaining patients. No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality. IVT was associated with higher likelihood of 3-month FI [odds ratio (OR), 2.19; 95% confidence intervals (CI), 1.09–4.42], 3-month favorable functional outcome (OR, 1.99; 95% CI, 1.10–3.57), functional improvement at discharge [common OR (per 1-point decrease in mRS score), 2.94; 95% CI, 1.67–5.26)] and at 3 months (common OR, 1.72; 95% CI, 1.06–2.86) on multivariable logistic regression models adjusting for potential confounders, including mechanical thrombectomy. Conclusions: Intravenous thrombolysis is independently associated with higher odds of improved discharge and 3-month functional outcomes in AIS patients with large vessel or distal occlusions and mild stroke severity. IVT appears not to increase the risk of systemic or symptomatic intracranial bleeding. © 2020 European Academy of Neurology
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