Ischemic stroke subtype is associated with outcome in thrombolyzed patients

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  • Marie Louise Schmitz, Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Claus Ziegler Simonsen
  • M L Svendsen
  • Heidi Jeanet Larsson
  • ,
  • Mette Hjørringgaard Madsen, Institut for Klinisk Medicin - Neuroradiologisk afdeling, NBG, Denmark
  • I K Mikkelsen
  • M Fisher, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. , United States
  • Søren Paaske Johnsen
  • ,
  • Grethe Andersen
OBJECTIVES: The impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is sparsely examined. We studied the association between stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-evaluated patients treated with IV-tPA.

MATERIAL AND METHODS: We conducted a single-center retrospective analysis of MRI-selected stroke patients treated with IV-tPA between 2004 and 2010. The Trial of ORG 10172 in Acute Stroke Treatment criteria were used to establish the stroke subtype by 3 months. The outcomes of interest were a 3-month modified Rankin Scale score of 0-1 (favorable outcome), and early neurological improvement defined as complete remission of neurological deficit or improvement of ≥4 on the National Institute of Health Stroke Scale at 24 h. The outcomes among stroke subtypes were compared with multivariable logistic regression.

Among 557 patients, 202 (36%) had large vessel disease (LVD), 153 (27%) cardioembolic stroke (CE), 109 (20%) small vessel disease, and 93 (17%) were of other or undetermined etiology. Early neurological improvement was present in 313 (56.4%) patients, and 361 (64.8%) patients achieved a favorable outcome. Early neurological improvement and favorable outcome were more likely in CE patients compared with LVD patients (odds ratio (OR), 2.1 (95% confidence interval, 1.4-3.3), and 2.0 (95% confidence interval, 1.2-3.3), respectively).

CONCLUSIONS: Cardioembolic stroke patients were more likely to achieve early neurological improvement and favorable outcome compared with LVD stroke following MRI-based IV-tPA treatment. This finding may reflect a difference in the effect of IV-tPA among stroke subtypes.
Original languageEnglish
Book seriesActa Neurologica Scandinavica. Supplementum
Pages (from-to)176-182
Publication statusPublished - Feb 2017

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