Thrombolysis in ischemic stroke without arterial occlusion at presentation

Sourabh Lahoti; Sankalp Gokhale; Louis Caplan; Patrik Michel; Yves Samson; Charlotte Rosso; Kaustubh Limaye; Archana Hinduja; Aneesh Singhal; Syed Ali; Luther Creed Pettigrew; Richard Kryscio; Nikita Dedhia; Shirish Hastak; David S Liebeskind

doi:10.1161/STROKEAHA.114.005757

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Thrombolysis in ischemic stroke without arterial occlusion at presentation

Journal article

Peer reviewed

Thrombolysis in ischemic stroke without arterial occlusion at presentation

Sourabh Lahoti, Sankalp Gokhale, Louis Caplan, Patrik Michel, Yves Samson, Charlotte Rosso, Kaustubh Limaye, Archana Hinduja, Aneesh Singhal, Syed Ali, …

Stroke (1970), Vol.45(9), pp.2722-2727

09/2014

DOI: 10.1161/STROKEAHA.114.005757

PMID: 25074517

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Abstract

None of the randomized trials of intravenous tissue-type plasminogen activator reported vascular imaging acquired before thrombolysis. Efficacy of tissue-type plasminogen activator in stroke without arterial occlusion on vascular imaging remains unknown and speculative. We performed a retrospective, multicenter study to collect data of patients who presented to participating centers during a 5-year period with ischemic stroke diagnosed by clinical examination and MRI and with imaging evidence of no vascular occlusion. These patients were divided into 2 groups: those who received thrombolytic therapy and those who did not. Primary outcome measure of the study was excellent clinical outcome defined as modified Rankin Scale of 0 to 1 at 90 days from stroke onset. Secondary outcome measures were good clinical outcome (modified Rankin Scale, 0-2) and perfect outcome (modified Rankin Scale, 0). Safety outcome measures were incidence of symptomatic intracerebral hemorrhage and poor outcome (modified Rankin Scale, 4-6). A total of 256 patients met study criteria, 103 with thrombolysis and 153 without. Logistic regression analysis showed that patients who received thrombolysis had more frequent excellent outcomes with odds ratio of 3.79 (P<0.01). Symptomatic intracerebral hemorrhage was more frequent in thrombolysis group (4.9 versus 0.7%; P=0.04). Thrombolysis led to more frequent excellent outcome in nonlacunar group with odds ratio 4.90 (P<0.01) and more frequent perfect outcome in lacunar group with odds ratio 8.25 (P<0.01). This study provides crucial data that patients with ischemic stroke who do not have visible arterial occlusion at presentation may benefit from thrombolysis.

Brain Ischemia - therapy

Humans

Middle Aged

Risk Factors

Male

Treatment Outcome

International Cooperation

Young Adult

Magnetic Resonance Imaging

Regression Analysis

Adolescent

Thrombolytic Therapy - methods

Aged, 80 and over

Adult

Female

Aged

Retrospective Studies

Infusions, Intravenous

Odds Ratio

Stroke - therapy

Arterial Occlusive Diseases - therapy

Details

Title: Subtitle: Thrombolysis in ischemic stroke without arterial occlusion at presentation
Creators: Sourabh Lahoti - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.). dr.s.lahoti@gmail.com
Sankalp Gokhale - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Louis Caplan - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Patrik Michel - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Yves Samson - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Charlotte Rosso - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Kaustubh Limaye - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Archana Hinduja - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Aneesh Singhal - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Syed Ali - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Luther Creed Pettigrew - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Richard Kryscio - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Nikita Dedhia - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Shirish Hastak - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
David S Liebeskind - From the Department of Neurology (S.L., L.C.P.) and Department of Biostatistics (R.K.), University of Kentucky, Lexington; Department of Neurology, Duke University Medical Center, Durham, NC (S.G); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.C.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (P.M.); Department of Neurology, Pitié-Salpêtrière Hospital, APHP, University Pierre et Marie Curie, Paris, France (Y.S., C.R.); Department of Neurology, University of Arkansas, Little Rock (K.L., A.H.); Department of Neurology, Massachusetts General Hospital, Boston (A.S., S.A.); Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India (N.D., S.H.); and University of California, Los Angeles (D.S.L.)
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.45(9), pp.2722-2727
DOI: 10.1161/STROKEAHA.114.005757
PMID: 25074517
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Publisher: United States
Language: English
Date published: 09/2014
Academic Unit: Neurology; Radiology
Record Identifier: 9984013111302771

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