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Erschienen in: Neurological Sciences 2/2019

01.02.2019 | Original Article

Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome

verfasst von: Monica Bandettini di Poggio, Cinzia Finocchi, Federica Brizzo, Fiorella Altomonte, Francesca Bovis, Nicola Mavilio, Carlo Serrati, Laura Malfatto, GianLuigi Mancardi, Maurizio Balestrino

Erschienen in: Neurological Sciences | Ausgabe 2/2019

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Abstract

Background and aims

Monitoring the quality of acute ischemic stroke (AIS) management is increasingly important since patient outcome could be improved with better access to evidence-based treatments. In this scenario, the aim of our study was to identify thrombolysis rate, reasons for undertreatment, and factors associated with better outcome.

Methods

From January to December 2016, individuals diagnosed with AIS at the Policlinic San Martino Hospital in Genoa, Italy, were prospectively included. Severity of stroke, site of occlusion, rate and time related in-hospital management of systemic thrombolysis, and mechanical thrombectomy were recorded. Safety and clinical outcomes were compared between different subgroups.

Results

Of 459 AIS patients (57.3% females, mean age 78.1), 111 received i.v. thrombolysis (24.4%) and 50 received mechanical thrombectomy (10.9%). Apart from arrival behind the therapeutic window, which was the first limitation to thrombolysis, the main reason of undertreatment was minor stroke or stroke in rapid improvement. Baseline NIHSS ≥ 8 was associated with unfavorable clinical outcome (mRS > 2) (OR 20.1; 95% CI, 1.1–387.4, p = 0.047). Age older than 80 years (OR 5.0; 95% CI, 1.4–64.1, p = 0.01), baseline NIHSS ≥ 7 (OR 20.1; 95% CI, 1.1–387.4, p = 0.047), and symptomatic intracranial hemorrhage (OR 22.9; 95% CI, 2.0–254.2, p = 0.01) proved independently associated with mortality.

Conclusions

i.v. thrombolysis and mechanical thrombectomy rate was higher than that of previous reports. Minor stroke or stroke in rapid improvement was a major reason for exclusion from thrombolysis of eligible patients. Higher NIHSS proved an independent predictor of unfavorable clinical outcome and death. Strategies to avoid in-hospital delays need to be enforced.
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Metadaten
Titel
Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome
verfasst von
Monica Bandettini di Poggio
Cinzia Finocchi
Federica Brizzo
Fiorella Altomonte
Francesca Bovis
Nicola Mavilio
Carlo Serrati
Laura Malfatto
GianLuigi Mancardi
Maurizio Balestrino
Publikationsdatum
01.02.2019
Verlag
Springer International Publishing
Erschienen in
Neurological Sciences / Ausgabe 2/2019
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-018-3644-3

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