Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis

2020 ◽  
Vol 27 (12) ◽  
pp. 2453-2462
Author(s):  
A. H. Katsanos ◽  
A. V. Alexandrov ◽  
P. Mandava ◽  
M. Köhrmann ◽  
L. Soinne ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Pulse Pressure ◽  
Intravenous Thrombolysis ◽  
Stroke Patients

scholarly journals Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

2021 ◽  
pp. 197140092110091
Author(s):  
Hanna Styczen ◽  
Matthias Gawlitza ◽  
Nuran Abdullayev ◽  
Alex Brehm ◽  
Carmen Serna-Candel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy

2021 ◽  
pp. 1-8
Author(s):  
Hongmin Li ◽  
Suliman Khan ◽  
Rabeea Siddique ◽  
Qian Bai ◽  
Yang Liu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Thrombolysis Therapy

scholarly journals Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chaohua Cui ◽  
Yanbo Li ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
Lijie Gao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Low Dose ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Risk Of Bleeding

Abstract Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

scholarly journals Low and Medium dose Statins Improve Function and Prognosis of Asian Ischemic Stroke Patients with Intravenous Thrombolysis

2021 ◽  
Author(s):  
Chaohua Cui ◽  
Jiajia Bao ◽  
Lijie Gao ◽  
Li He
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Score Improvement ◽  
Medium Dose

Abstract Background: For acute ischaemic stroke, intravenous thrombolysis combined with statins might increase the therapeutic effect; however, it is uncertain whether this is effective. Additionally, statins can increase the risk of intracerebral haemorrhage in ischaemic stroke patients, further raising doubts regarding the safety of this combination. Methods: Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events in the hospital and death events within 2 years. Results: The study finally included 222 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p<0.001) and a higher percentage of a favourable functional outcome (FFO) (p<0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p<0.001) and gastrointestinal haemorrhage (p=0.004) in the hospital and a lower percentage of death events (p<0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR=2.291, p=0.014), a lower percentage of intracerebral haemorrhage (OR=0.379, p=0.008) and gastrointestinal haemorrhage (OR=0.027, p=0.023), and a lower percentage of death events (OR=0.196, p<0.001). Conclusion: For Asian acute ischaemic stroke patients after intravenous thrombolysis, the use of low- and medium-dose statins was related to NIHSS improvement of moderate stroke patients at 7 days, with a reduced percentage of haemorrhage events in the hospital and a lower percentage of death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

scholarly journals Intra-Arterial Therapy as a Rescue Strategy after Clinically Failed Intravenous Thrombolysis May Increase the Likelihood of a Good Outcome in Patients with Severe Ischaemic Stroke

2014 ◽  
Vol 20 (3) ◽  
pp. 329-335
Author(s):  
Federico Menetti ◽  
Luca Verganti ◽  
Andrea Zini ◽  
Stefano Vallone ◽  
Paolo Carpeggiani ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Rescue Therapy ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Study Group ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Nihss Score ◽  
Haemorrhage Rate

The purpose of this study was to evaluate the efficacy and safety of intra-arterial therapy as a rescue strategy after clinically failed intravenous thrombolysis (IVT) in acute ischaemic stroke patients. We conducted a retrospective analysis of consecutive acute ischaemic stroke patients treated with rescue therapy. The results from this study group were compared with those obtained from a control group consisting of 260 consecutive patients treated with IVT alone. The study group consisted of 52 patients with a mean age of 63 years and a median NIHSS score at admission of 17. Recanalization was achieved in 92% with a symptomatic haemorrhage rate of 9.6%. Rescue patients admitted with a severe stroke (NIHSS score >12) had a significantly better outcome at 90 days compared to patients with the same score but treated with IVT alone. No difference was seen for patients with a lower score at admission. This study indicates that rescue therapy may increase the proportion of patients with independent outcome if presenting with a severe stroke (NIHSS score >12) without increasing the rate of symptomatic haemorrhage.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

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