Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study.

Détails

ID Serval
serval:BIB_D5A07D597992
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study.
Périodique
European journal of neurology
Auteur(s)
Ajili N., Decroix J.P., Preda C., Labreuche J., Lopez D., Bejot Y., Michel P., Sévin-Allouet M., Sibon I., Vergnet S., Wang A., Sanda N., Mazighi M., Bourdain F., Lapergue B.
ISSN
1468-1331 (Electronic)
ISSN-L
1351-5101
Statut éditorial
Publié
Date de publication
08/2016
Peer-reviewed
Oui
Volume
23
Numéro
8
Pages
1380-1386
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Observational Study
Publication Status: ppublish
Résumé
The impact of intravenous recombinant tissue plasminogen activator (IV-rtPA) in patients with acute ischaemic stroke (AIS) but no arterial occlusion is currently a matter of debate. This study aimed to assess functional outcome of such patients with respect to IV-rtPA use.
A retrospective case-control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV-rtPA use. Patients were selected from prospective consecutive observational registries of five European university hospitals. The primary study outcome was excellent outcome at 3 months after stroke, as defined by a modified Rankin Scale (mRS) 0-1.
A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV-rtPA and 188 did not. No between-group difference was found for excellent outcome before and after adjustment for baseline characteristics (adjusted odds ratio for no IV-rtPA use 0.79, 95% confidence interval 0.51-1.24, P = 0.31). Similar results were found for favourable outcome (defined as a 90-day mRS of 0-2) whereas a higher rate of early neurological improvement was found in IV-rtPA-treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29-3.07, P = 0.002). Sensitivity analyses yielded similar results.
Our study suggests that AIS patients without visible arterial occlusion treated with IV-rtPA may have no better outcome at 3 months than those untreated. However, only a randomized controlled trial would provide a definitive answer about the impact of rtPA in acute stroke patients without occlusion. Until then, these patients should be treated by rtPA as recommended.

Mots-clé
Administration, Intravenous, Aged, Aged, 80 and over, Brain Ischemia/drug therapy, Female, Fibrinolytic Agents/administration & dosage, Fibrinolytic Agents/therapeutic use, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Stroke/drug therapy, Thrombolytic Therapy/methods, Tissue Plasminogen Activator/administration & dosage, Tissue Plasminogen Activator/therapeutic use, Treatment Outcome, arterial occlusion, ischaemic stroke, outcome, thrombolysis
Pubmed
Web of science
Création de la notice
06/06/2016 17:10
Dernière modification de la notice
20/08/2019 16:55
Données d'usage