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Tytuł:
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Treatment of patients with mild acute ischemic stroke and associated large vessel occlusion.
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Autorzy:
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Cerejo R; Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.
Cheng-Ching E; Department of Neurology, Miami Valley Hospital, Dayton, OH, USA.
Hui F; Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.
Hussain MS; Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.
Uchino K; Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.
Bullen J; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Toth G; Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA. Electronic address: .
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Źródło:
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Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2016 Aug; Vol. 30, pp. 60-64. Date of Electronic Publication: 2016 Apr 03.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: <2000->: Edinburgh : Churchill Livingstone
Original Publication: Melbourne, Vic., Australia : Churchill Livingstone, c1994-
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MeSH Terms:
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Fibrinolytic Agents/*administration & dosage
Stroke/*drug therapy
Stroke/*pathology
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Thrombolytic Therapy/methods ; Tissue Plasminogen Activator/administration & dosage ; Treatment Outcome
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Contributed Indexing:
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Keywords: Acute stroke therapy; Large vessel occlusion; Mild ischemic stroke
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Substance Nomenclature:
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0 (Fibrinolytic Agents)
EC 3.4.21.68 (Tissue Plasminogen Activator)
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Entry Date(s):
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Date Created: 20160407 Date Completed: 20170227 Latest Revision: 20181202
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Update Code:
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20240104
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DOI:
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10.1016/j.jocn.2015.12.029
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PMID:
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27050916
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Several recent studies have shown that patients presenting with mild acute ischemic stroke (mAIS) symptoms may have an unfavorable natural history. The presence of associated large vessel occlusion (LVO) may lead to even worse outcomes, but most mAIS patients are still excluded from acute stroke treatment (AST). A retrospective review of patients with acute ischemic stroke presenting to our institution between 2010 and 2014 was carried out. Inclusion criteria were mAIS (initial National Institutes of Health Stroke Scale [NIHSS] ⩽7) due to LVO, presenting within 6hours from onset. Demographics, treatments and short-term outcomes were analyzed. Favorable 30day outcome was defined as modified Rankin Scale (mRS) ⩽2. Out of 2636 patients, 62 patients (median age 63years, 33 (53.2%) males) met inclusion criteria. The anterior circulation was involved in 74.1%. Median admission NIHSS and pre-admission mRS were 4 and 0, respectively. Twenty-three patients (71.8%) received AST (intravenous tissue plasminogen activator: 14, intra-arterial therapy: 4, both: 5). Favorable outcomes were 4.5 times higher in treated (78.3%) versus untreated (53.8%) patients (odds ratio 4.5, 95% confidence interval 1.26-19.2; p=0.028). None of the treated patients had symptomatic intracranial hemorrhage. We demonstrate that a significant proportion of untreated mAIS patients with LVO have an unfavorable natural history. Our results suggest better outcomes in patients who receive early therapy rather than conservative management. The detection of LVO, even with mild clinical symptoms, may prompt rapid treatment considerations.
(Copyright © 2016 Elsevier Ltd. All rights reserved.)
