Cargando…

Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

BACKGROUND AND PURPOSE: Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. ME...

Descripción completa

Detalles Bibliográficos
Autores principales: Tsivgoulis, Georgios, Saqqur, Maher, Sharma, Vijay K., Brunser, Alejandro, Eggers, Jürgen, Mikulik, Robert, Katsanos, Aristeidis H., Sergentanis, Theodore N., Vadikolias, Konstantinos, Perren, Fabienne, Rubiera, Marta, Bavarsad Shahripour, Reza, Nguyen, Huy Thang, Martínez-Sánchez, Patricia, Safouris, Apostolos, Heliopoulos, Ioannis, Shuaib, Ashfaq, Derksen, Carol, Voumvourakis, Konstantinos, Psaltopoulou, Theodora, Alexandrov, Anne W., Alexandrov, Andrei V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Stroke Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005347/
https://www.ncbi.nlm.nih.gov/pubmed/32027798
http://dx.doi.org/10.5853/jos.2019.01648
_version_ 1783494917489688576
author Tsivgoulis, Georgios
Saqqur, Maher
Sharma, Vijay K.
Brunser, Alejandro
Eggers, Jürgen
Mikulik, Robert
Katsanos, Aristeidis H.
Sergentanis, Theodore N.
Vadikolias, Konstantinos
Perren, Fabienne
Rubiera, Marta
Bavarsad Shahripour, Reza
Nguyen, Huy Thang
Martínez-Sánchez, Patricia
Safouris, Apostolos
Heliopoulos, Ioannis
Shuaib, Ashfaq
Derksen, Carol
Voumvourakis, Konstantinos
Psaltopoulou, Theodora
Alexandrov, Anne W.
Alexandrov, Andrei V.
author_facet Tsivgoulis, Georgios
Saqqur, Maher
Sharma, Vijay K.
Brunser, Alejandro
Eggers, Jürgen
Mikulik, Robert
Katsanos, Aristeidis H.
Sergentanis, Theodore N.
Vadikolias, Konstantinos
Perren, Fabienne
Rubiera, Marta
Bavarsad Shahripour, Reza
Nguyen, Huy Thang
Martínez-Sánchez, Patricia
Safouris, Apostolos
Heliopoulos, Ioannis
Shuaib, Ashfaq
Derksen, Carol
Voumvourakis, Konstantinos
Psaltopoulou, Theodora
Alexandrov, Anne W.
Alexandrov, Andrei V.
author_sort Tsivgoulis, Georgios
collection PubMed
description BACKGROUND AND PURPOSE: Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. METHODS: We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0–1 and 0–2 respectively. RESULTS: We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (jos-2019-01648P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). CONCLUSIONS: Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.
format Online
Article
Text
id pubmed-7005347
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Korean Stroke Society
record_format MEDLINE/PubMed
spelling pubmed-70053472020-02-13 Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke Tsivgoulis, Georgios Saqqur, Maher Sharma, Vijay K. Brunser, Alejandro Eggers, Jürgen Mikulik, Robert Katsanos, Aristeidis H. Sergentanis, Theodore N. Vadikolias, Konstantinos Perren, Fabienne Rubiera, Marta Bavarsad Shahripour, Reza Nguyen, Huy Thang Martínez-Sánchez, Patricia Safouris, Apostolos Heliopoulos, Ioannis Shuaib, Ashfaq Derksen, Carol Voumvourakis, Konstantinos Psaltopoulou, Theodora Alexandrov, Anne W. Alexandrov, Andrei V. J Stroke Original Article BACKGROUND AND PURPOSE: Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. METHODS: We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0–1 and 0–2 respectively. RESULTS: We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (jos-2019-01648P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). CONCLUSIONS: Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions. Korean Stroke Society 2020-01 2020-01-31 /pmc/articles/PMC7005347/ /pubmed/32027798 http://dx.doi.org/10.5853/jos.2019.01648 Text en Copyright © 2020 Korean Stroke Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Tsivgoulis, Georgios
Saqqur, Maher
Sharma, Vijay K.
Brunser, Alejandro
Eggers, Jürgen
Mikulik, Robert
Katsanos, Aristeidis H.
Sergentanis, Theodore N.
Vadikolias, Konstantinos
Perren, Fabienne
Rubiera, Marta
Bavarsad Shahripour, Reza
Nguyen, Huy Thang
Martínez-Sánchez, Patricia
Safouris, Apostolos
Heliopoulos, Ioannis
Shuaib, Ashfaq
Derksen, Carol
Voumvourakis, Konstantinos
Psaltopoulou, Theodora
Alexandrov, Anne W.
Alexandrov, Andrei V.
Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_full Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_fullStr Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_full_unstemmed Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_short Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_sort timing of recanalization and functional recovery in acute ischemic stroke
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005347/
https://www.ncbi.nlm.nih.gov/pubmed/32027798
http://dx.doi.org/10.5853/jos.2019.01648
work_keys_str_mv AT tsivgoulisgeorgios timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT saqqurmaher timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT sharmavijayk timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT brunseralejandro timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT eggersjurgen timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT mikulikrobert timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT katsanosaristeidish timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT sergentanistheodoren timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT vadikoliaskonstantinos timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT perrenfabienne timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT rubieramarta timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT bavarsadshahripourreza timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT nguyenhuythang timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT martinezsanchezpatricia timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT safourisapostolos timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT heliopoulosioannis timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT shuaibashfaq timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT derksencarol timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT voumvourakiskonstantinos timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT psaltopouloutheodora timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT alexandrovannew timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT alexandrovandreiv timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke
AT timingofrecanalizationandfunctionalrecoveryinacuteischemicstroke