TY - JOUR
TI - Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window
AU - Tsivgoulis, G.
AU - Katsanos, A.H.
AU - Malhotra, K.
AU - Sarraj, A.
AU - Barreto, A.D.
AU - Köhrmann, M.
AU - Krogias, C.
AU - Ahmed, N.
AU - Caso, V.
AU - Schellinger, P.D.
AU - Alexandrov, A.V.
AU - Tsivgoulis, G.
JO - Functional Neurology
PY - 2020
VL - 94
TODO - 12
SP - e1241-e1248
PB - Lippincott Williams and Wilkins
SN - null
TODO - 10.1212/WNL.0000000000008904
TODO - alteplase;  fibrinolytic agent;  tissue plasminogen activator, adult;  aged;  all cause mortality;  Article;  blood clot lysis;  brain hemorrhage;  brain ischemia;  controlled study;  disease course;  female;  Functional Independence Measure;  human;  major clinical study;  male;  mortality risk;  neuroimaging;  priority journal;  randomized controlled trial;  Rankin scale;  recanalization;  treatment outcome;  brain ischemia;  cerebrovascular accident;  diagnostic imaging;  fibrinolytic therapy;  intravenous drug administration;  meta analysis;  procedures;  time to treatment, Administration, Intravenous;  Brain Ischemia;  Fibrinolytic Agents;  Humans;  Neuroimaging;  Stroke;  Thrombolytic Therapy;  Time-to-Treatment;  Tissue Plasminogen Activator;  Treatment Outcome
TODO - ObjectiveTo assess the utility of IV thrombolysis (IVT) treatment in patients with acute ischemic stroke (AIS) with unclear symptom onset time or outside the 4.5-hour time window selected by advanced neuroimaging.MethodsWe performed random-effects meta-Analyses on the unadjusted and adjusted for potential confounders associations of IVT (alteplase 0.9 mg/kg) with the following outcomes: 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] scores 0-1), 3-month functional independence (FI; mRS scores 0-2), 3-month mortality, 3-month functional improvement (assessed with ordinal analysis on the mRS scores), symptomatic intracranial hemorrhage (sICH), and complete recanalization (CR).ResultsWe identified 4 eligible randomized clinical trials (859 total patients). In unadjusted analyses, IVT was associated with a higher likelihood of 3-month FFO (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.12-1.96), FI (OR 1.42, 95% CI 1.07-1.90), sICH (OR 5.28, 95% CI 1.35-20.68), and CR (OR 3.29, 95% CI 1.90-5.69), with no significant difference in the odds of all-cause mortality risk at 3 months (OR 1.75, 95% CI 0.93-3.29). In the adjusted analyses, IVT was also associated with higher odds of 3-month FFO (adjusted OR [ORadj] 1.62, 95% CI 1.20-2.20), functional improvement (ORadj 1.42, 95% CI 1.11-1.81), and sICH (ORadj 6.22, 95% CI 1.37-28.26). There was no association between IVT and FI (ORadj 1.61, 95% CI 0.94-2.75) or all-cause mortality (ORadj 1.75, 95% CI 0.93-3.29) at 3 months. No evidence of heterogeneity was evident in any of the analyses (I2 = 0).ConclusionIVT in patients with AIS with unknown symptom onset time or elapsed time from symptom onset >4.5 hours selected with advanced neuroimaging results in a higher likelihood of CR and functional improvement at 3 months despite the increased risk of sICH. © American Academy of Neurology.
ER -