The online version of this article (https://doi.org/10.1186/s12883-018-1033-4) contains supplementary material, which is available to authorized users.
A significant proportion of patients with mild ischemic stroke become disabled despite receiving intravenous thrombolytic therapy. The purpose of this study was to assess the clinical and radiological factors associated with unfavorable outcomes in patients with minor ischemic stroke that received intravenous recombinant tissue plasminogen activator (rt-PA) therapy.
We identified anterior circulation stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 who received intravenous thrombolysis within 4.5 h of stroke onset and had pretreatment magnetic resonance (MR)/MR angiography using our prospective stroke database. We analyzed baseline characteristics, infarction patterns on diffusion-weighted imaging (DWI), and steno-occlusive lesions on MR angiography. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score ≥ 2 at 90 days. Logistic regression was used to determine independent predictors of unfavorable outcomes.
Among 121 patients (85 men; mean age, 63.4 ± 11.3 years) included in this study, 46 (38%) had unfavorable outcomes at 90 days and DWI lesion patterns showing infarction in the deep middle cerebral artery (MCA) territory involving the perforating artery area was observed in 47 (38.8%) patients. On multivariable analysis, unfavorable outcomes at 90 days were associated with diabetes [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.06–10.9; P = 0.039), NIHSS score on admission (OR, 2.11; 95% CI, 1.35–3.30; P = 0.001), and infarction in the deep MCA territory on DWI (OR, 4.19; 95% CI, 1.63–10.8; P = 0.003). Lesions in the deep MCA territory was independently associated with early neurological deterioration (P = 0.032). The patients without deep MCA territory infarction had a higher prevalence of cardiac embolism (P = 0.009).
Higher NIHSS scores, diabetes, and deep MCA territory infarction may be useful for predicting unfavorable outcomes in patients with minor stroke treated with intravenous rt-PA therapy.
Additional file 1: Table S1. Univariate and multivariable analysis of factors associated with Group A lesion pattern in diffusion-weighted imaging. (DOCX 18 kb)12883_2018_1033_MOESM1_ESM.docx
Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Cho KH, Kim JT, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee JS, Yoon BW, Bae HJ. Case characteristics, hyperacute treatment, and outcome information from the clinical research center for stroke-fifth division registry in South Korea. J Stroke. 2015;17:38–53. CrossRefPubMedPubMedCentral
Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M, Koga M, von Kummer R, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J, Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384:1929–35. CrossRefPubMedPubMedCentral
Romano JG, Smith EE, Liang L, Gardener H, Camp S, Shuey L, Cook A, Campo-Bustillo I, Khatri P, Bhatt DL, Fonarow GC, Sacco RL, Schwamm LH. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the get with the guidelines-stroke registry. JAMA Neurol. 2015;72:423–31. CrossRefPubMed
Coutts SB, Modi J, Patel SK, Aram H, Demchuk AM, Goyal M, Hill MD. What causes disability after transient ischemic attack and minor stroke?: results from the CT and MRI in the triage of TIA and minor cerebrovascular events to identify high risk patients (CATCH) study. Stroke. 2012;43:3018–22. CrossRefPubMed
Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian acute stroke study investigators. Lancet. 1998;352:1245–51. CrossRefPubMed
Strbian D, Ringleb P, Michel P, Breuer L, Ollikainen J, Murao K, Seiffge DJ, Jung S, Obach V, Weder B, Eskandari A, Gensicke H, Chamorro A, Mattle HP, Engelter S, Leys D, Numminen H, Kohrmann M, Hacke W, Tatlisumak T. Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly? Stroke. 2013;44:2913–6. CrossRefPubMed
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