Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population.

Details

Serval ID
serval:BIB_FA23FBDF584C
Type
Article: article from journal or magazin.
Collection
Publications
Title
Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population.
Journal
Journal of Neurology, Neurosurgery, and Psychiatry
Author(s)
Delgado M.G., Michel P., Naves M., Maeder P., Reichhart M., Wintermark M., Bogousslavsky J.
ISSN
1468-330X (Electronic)
ISSN-L
0022-3050
Publication state
Published
Issued date
2010
Volume
81
Number
3
Pages
282-285
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
BACKGROUND: Intravenous recombinant tissular plasminogen activator (rt-PA) is the only approved pharmacological treatment for acute ischaemic stroke. The authors aimed to analyse potential causes of the variable effect on early course and late outcome.
METHODS AND RESULTS: 136 patients (42% women, 58% men) treated with intravenous rt-PA within 3 h of stroke onset in an acute stroke unit over a 3-year period, were included. Early clinical profiles of evolution at 48 h were divided into clinical improvement (CI) (decrease >4 points in the National Institute of Health Stroke Scale (NIHSS)); clinical worsening (CW) (increase >4 points NIHSS); clinical worsening after initial improvement (CWFI) (variations of >4 points in the NIHSS). Patients with clinical stability (no NIHSS modification or <4 points) were excluded. The patients showed in 66.9% CI, 13.2% CW 8.1 % CWFI and 11.8% remained stable. Female sex, no hyperlipaemia and peripheral arterial disease were associated with CW. Male sex and smoking were associated with CI. Absence of arterial occlusion on admission (28.4%) and arterial recanalisation at 24 h were associated with CI. Main causes of clinical deterioration included symptomatic intracranial haemorrhage (sICH), persistent occlusion and cerebral oedema. 23.5% developed ICH, 6.6% of which had sICH. At 3 months, 15.5% had died. Mortality was increased in CW, mainly related to sICH and cerebral oedema. The outcome of CWFI was intermediate between CW and CI.
CONCLUSIONS: Early clinical profiles of evolution in thrombolysed patients vary considerably. Even with CI, it is critical to maintain vessel permeability to avoid subsequent CW.
Keywords
Adult, Aged, Aged, 80 and over, Brain Edema/diagnosis, Brain Edema/mortality, Cerebral Angiography, Cerebral Infarction/diagnosis, Cerebral Infarction/drug therapy, Disease Progression, Female, Fibrinolytic Agents/administration & dosage, Fibrinolytic Agents/adverse effects, Humans, Intracranial Hemorrhages/chemically induced, Intracranial Hemorrhages/diagnosis, Intracranial Hypertension/diagnosis, Intracranial Hypertension/mortality, Male, Middle Aged, Neurologic Examination/drug effects, Prognosis, Recurrence, Sex Factors, Survival Rate, Thrombolytic Therapy, Tissue Plasminogen Activator/administration & dosage, Tissue Plasminogen Activator/adverse effects, Tomography, Spiral Computed, Treatment Outcome, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
26/11/2009 17:17
Last modification date
09/12/2020 7:26
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