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

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Title: Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study.
Authors: 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.
Source: European Journal of Neurology. Aug2016, Vol. 23 Issue 8, p1380-1386. 7p.
Subjects: Thrombolytic therapy, Stroke, Cerebrovascular disease, Occlusion (Chemistry), Brain diseases
Abstract: Background and purpose The impact of intravenous recombinant tissue plasminogen activator (IV-rt PA) 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-rt PA use. Methods A retrospective case−control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV-rt PA 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. Results A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV-rt PA 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-rt PA 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-rt PA-treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29-3.07, P = 0.002). Sensitivity analyses yielded similar results. Conclusions Our study suggests that AIS patients without visible arterial occlusion treated with IV-rt PA 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 rt PA in acute stroke patients without occlusion. Until then, these patients should be treated by rt PA as recommended. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study.
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  Data: <searchLink fieldCode="AR" term="%22Ajili%2C+N%2E%22">Ajili, N.</searchLink><br /><searchLink fieldCode="AR" term="%22Decroix%2C+J%2E+P%2E%22">Decroix, J. P.</searchLink><br /><searchLink fieldCode="AR" term="%22Preda%2C+C%2E%22">Preda, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Labreuche%2C+J%2E%22">Labreuche, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Lopez%2C+D%2E%22">Lopez, D.</searchLink><br /><searchLink fieldCode="AR" term="%22Bejot%2C+Y%2E%22">Bejot, Y.</searchLink><br /><searchLink fieldCode="AR" term="%22Michel%2C+P%2E%22">Michel, P.</searchLink><br /><searchLink fieldCode="AR" term="%22Sévin+‐+Allouet%2C+M%2E%22">Sévin ‐ Allouet, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Sibon%2C+I%2E%22">Sibon, I.</searchLink><br /><searchLink fieldCode="AR" term="%22Vergnet%2C+S%2E%22">Vergnet, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Wang%2C+A%2E%22">Wang, A.</searchLink><br /><searchLink fieldCode="AR" term="%22Sanda%2C+N%2E%22">Sanda, N.</searchLink><br /><searchLink fieldCode="AR" term="%22Mazighi%2C+M%2E%22">Mazighi, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Bourdain%2C+F%2E%22">Bourdain, F.</searchLink><br /><searchLink fieldCode="AR" term="%22Lapergue%2C+B%2E%22">Lapergue, B.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Aug2016, Vol. 23 Issue 8, p1380-1386. 7p.
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  Data: <searchLink fieldCode="DE" term="%22Thrombolytic+therapy%22">Thrombolytic therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Stroke%22">Stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebrovascular+disease%22">Cerebrovascular disease</searchLink><br /><searchLink fieldCode="DE" term="%22Occlusion+%28Chemistry%29%22">Occlusion (Chemistry)</searchLink><br /><searchLink fieldCode="DE" term="%22Brain+diseases%22">Brain diseases</searchLink>
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  Label: Abstract
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  Data: Background and purpose The impact of intravenous recombinant tissue plasminogen activator (IV-rt PA) 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-rt PA use. Methods A retrospective case−control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV-rt PA 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. Results A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV-rt PA 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-rt PA 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-rt PA-treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29-3.07, P = 0.002). Sensitivity analyses yielded similar results. Conclusions Our study suggests that AIS patients without visible arterial occlusion treated with IV-rt PA 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 rt PA in acute stroke patients without occlusion. Until then, these patients should be treated by rt PA as recommended. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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