Τίτλος:
Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Tsivgoulis, G.
Katsanos, A.H.
Malhotra, K.
Sarraj, A.
Barreto, A.D.
Köhrmann, M.
Krogias, C.
Ahmed, N.
Caso, V.
Schellinger, P.D.
Alexandrov, A.V.
Tsivgoulis, G.
Περιοδικό:
Functional Neurology
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
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
DOI:
10.1212/WNL.0000000000008904
