Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population.
Détails
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Accès restreint UNIL
Etat: Public
Version: de l'auteur⸱e
ID Serval
serval:BIB_42AA13E2190C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population.
Périodique
Journal of neurology, neurosurgery, and psychiatry
ISSN
1468-330X (Electronic)
ISSN-L
0022-3050
Statut éditorial
Publié
Date de publication
03/2010
Peer-reviewed
Oui
Volume
81
Numéro
3
Pages
282-285
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
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.
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.
Early clinical profiles of evolution in thrombolysed patients vary considerably. Even with CI, it is critical to maintain vessel permeability to avoid subsequent CW.
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.
Early clinical profiles of evolution in thrombolysed patients vary considerably. Even with CI, it is critical to maintain vessel permeability to avoid subsequent CW.
Mots-clé
Adult, Aged, Aged, 80 and over, Brain Edema/diagnosis, Brain Edema/diagnostic imaging, Brain Edema/mortality, Cerebral Angiography, Cerebral Infarction/diagnosis, Cerebral Infarction/diagnostic imaging, Cerebral Infarction/drug therapy, Cerebral Infarction/mortality, Disease Progression, Female, Fibrinolytic Agents/administration & dosage, Fibrinolytic Agents/adverse effects, Humans, Intracranial Hemorrhages/chemically induced, Intracranial Hemorrhages/diagnosis, Intracranial Hemorrhages/diagnostic imaging, Intracranial Hemorrhages/mortality, Intracranial Hypertension/diagnosis, Intracranial Hypertension/diagnostic imaging, 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
Open Access
Oui
Création de la notice
07/12/2009 16:54
Dernière modification de la notice
20/08/2019 14:45