Web of Science: 35 citas, Scopus: 32 citas, Google Scholar: citas,
Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
Tsivgoulis, Georgios (Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis)
Saqqur, Maher (Department of Neuroscience, Hamad General Hospital, Doha)
Sharma, Vijay K. (Division of Neurology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore)
Brunser, Alejandro (Department of Emergency Medicine, Clinica Alemana of Santiago, University of Desarrollo, Santiago)
Eggers, Jürgen (Department of Neurology, Sana Hospital Lubeck, Lübeck)
Mikulik, Robert (Medical Faculty, Masaryk University, Brno)
Katsanos, Aristeidis H. (Department of Neurology, University of Ioannina School of Medicine, Ioannina)
Sergentanis, Theodore N. (Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens)
Vadikolias, Konstantinos (Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis)
Perren, Fabienne (Geneva University Hospitals (Suïssa))
Rubiera del Fueyo, Marta A. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bavarsad Shahripour, Reza (Department of Neurology, University of Alabama at Birmingham, Birmingham, AL)
Nguyen, Huy Thang (Department of Cerebrovascular Disease, 115 The People Hospital, Ho Chi Minh)
Martínez-Sánchez, Patricia (Complejo Hospitalario Torrecárdenas (Almeria))
Safouris, Apostolos (Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels)
Heliopoulos, Ioannis (Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis)
Shuaib, Ashfaq (Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB)
Derksen, Carol (Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB)
Voumvourakis, Konstantinos (University General Hospital Attikon (Haidari, Grècia))
Psaltopoulou, Theodora (Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens)
Alexandrov, Andrei V (Department of Neurology, University of Tennessee Health Science Center, Memphis, TN)
Alexandrov, Andrei V. (Department of Neurology, University of Alabama at Birmingham, Birmingham, AL)
Universitat Autònoma de Barcelona

Fecha: 2020
Resumen: 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. 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. 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-2019-01648 P <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). 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.
Derechos: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. Creative Commons
Lengua: Anglès
Documento: Article ; recerca ; Versió publicada
Materia: Thrombolysis ; Stroke ; Reperfusion ; Outcomes
Publicado en: Journal of Stroke, Vol. 22 (january 2020) , p. 130-140, ISSN 2287-6405

DOI: 10.5853/jos.2019.01648
PMID: 32027798


20 p, 1.7 MB

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