Do initial clinical symptoms affect the outcome of ischemic stroke patients with recanalization treatment?

Česká verzia

Authors: S. Halúsková ¹; R. Herzig ¹; D. Krajíčková ¹; A. Hamza ²; A. Krajina ³; V. Chovanec ³; Miroslav Lojík ³ ; J. Raupach ³; O. Renc ³; L. Šimůnek ¹; E. Vítková ¹; L. Sobíšek ¹; M. Vališ ¹
Authors place of work: Neurologická klinika, Komplexní cerebrovaskulární centrum, LF UK a FN Hradec Králové ¹; Neurologická klinika LF UK Hradec Králové ²; Radiologická klinika, Komplexní cerebrovaskulární centrum, LF UK a FN Hradec Králové ³
Published in the journal: Cesk Slov Neurol N 2021; 84(5): 456-464
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2021456

Summary

Aim: The aim was to assess the dependency of the 90-day clinical outcome on the initial symptoms of ischemic stroke (IS) in patients treated with intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). Materials and methods: In a retrospective, observational, one-center study, we assessed the effect of initial IS symptoms, achieved times and degree of recanalization on a 90-day clinical outcome in a set of 809 IS patients treated with IVT and/or EVT. Results: In the IVT group, age (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.91–0.96), baseline neurological deficit (OR = 0.91, 95% CI: 0.86–0.96), and the presence of limb paresis (OR = 0.51, 95% CI: 0.25–0.97) were identified as significant negative predictors of a good 90-day clinical outcome. In the EVT (± IVT) group, age (OR = 0.93, 95% CI: 0.91–0.95) and initial neurological deficit (OR = 0.84, 95% CI: 0.80–0.89) were identified as significant negative predictors and successful recanalization (OR = 4.31, 95% CI: 2.44–7.81) as a significant positive predictor of a good 90-day clinical outcome (P < 0.05 in all cases). Conclusions: Our results showed that the presence of limb paresis was associated with a worse clinical outcome in patients treated with IVT alone, while the presence of other IS symptoms did not affect a 90-day clinical outcome in patients treated with recanalization therapy

Keywords:

acute ischemic stroke – clinical symptoms – intravenous thrombolysis – endovascular therapy – clinical outcome

Zdroje

1. De Marchis GM, Kohler A, Renz N et al. Posterior versus anterior circulation strokes: comparison of clinical, radiological and outcome characteristics. J Neurol Neurosurg Psychiatry 2011; 82 (1): 33–37. doi: 10.1136/jnnp.2010.211151.

2. Dorňák T, Herzig R, Kuliha M et al. Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial. Clin Radiol 2015; 70 (5): e20–e27. doi: 10.1016/j.crad.2015.01.008.

3. Zürcher E, Richoz B, Faouzi M et al. Differences in ischemic anterior and posterior circulation strokes: a clinico-radiological and outcome analysis. J Stroke Cerebrovasc Dis 2019; 28 (3): 710–718. doi: 10.1016/j.jstroke cerebrovasdis.2018.11.016.

4. Frid P, Drake M, Giese AK et al. Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study. J Neurol 2020; 267 (3): 649–658. doi: 10.1007/s00415-019-09613-5.

5. Tao WD, Liu M, Fisher M et al. Posterior versus anterior circulation infarction: how different are the neurological deficits? Stroke 2012; 43 (8): 2060–2065. doi: 10.1161/STROKEAHA.112.652420.

6. Emberson J, Lees KR, Lyden P et al. 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 (9958): 1929–1935. doi: 10.1016/S0140-6736 (14) 60584-5.

7. Saver JL, Goyal M, van der Lugt A et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316 (12): 1279–1288. doi: 10.1001/jama.2016.13647.

8. Sarraj A, Medrek S, Albright K et al. Posterior circulation stroke is associated with prolonged door-to-needle time. Int J Stroke 2015; 10 (5): 672–678. doi: 10.1111/j.1747-4949.2012.00952.x.

9. Baraban E, Lucas L, Bhatt A. Initial presenting stroke symptoms impact treatment timeline among ischemic stroke patients [abstract]. Neurology 2018; 90 (Suppl 15): P4.233.

10. Halúsková S, Herzig R, Krajíčková D et al. Acute management should be optimized in patients with less specific stroke symptoms: findings from a retrospective observational study. J Clin Med 2021; 10 (5): 1143. doi: 10.3390/jcm10051143.

11. Jauch EC, Saver JL, Adams HP Jr et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (3): 870–947. doi: 10.1161/STR.0b013e318284056a.

12. Neumann J, Tomek A, Školoudík D et al. Doporučený postup pro intravenózní trombolýzu v léčbě akutního mozkového infarktu – verze 2014. Cesk Slov Neurol N 2014; 77/110 (3): 381–385.

13. Powers WJ, Derdeyn CP, Biller J et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (10): 3020–3035. doi: 10.1161/STR.0000000000000074.

14. Šaňák D, Neumann J, Tomek A et al. Doporučení pro rekanalizační léčbu akutního mozkového infarktu – verze 2016. Cesk Slov Neurol N 2016; 79/112 (2): 231–234.

15. Powers WJ, Rabinstein AA, Ackerson T et al. 2018 guidelines for the early management of patients with acute ischemic stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (3): e46–e110. doi: 10.1161/STR.0000000000000158.

16. Krajíčková D, Krajina A, Herzig R et al. Mechanical recanalization in ischemic anterior circulation stroke within an 8-hour time window. A real-world experience. Diagn Interv Radiol 2017; 23 (6): 465–471. doi: 10.5152/dir.2017.17049.

17. Sanák D, Nosáľ V, Horák D et al. Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology 2006; 48 (9): 632–639. doi: 10.1007/s00234-006-0105-0.

18. Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke 1997; 28 (2): 307–310. doi: 10.1161/01.str.28.2.307.

19. Hong KS, Saver JL. Quantifying the value of stroke disability outcomes: WHO global burden of disease project disability weights for each level of the modified Rankin Scale. Stroke 2009; 40 (12): 3828–3833. doi: 10.1161/STROKEAHA.109.561365.

20. Yoo AJ, Simonsen CZ, Prabhakaran S et al. Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 2013; 44 (9): 2509–2512. doi: 10.1161/STROKEAHA.113.001990.

21. Vergouwen MD, Algra A, Pfefferkorn T et al. Time is brain (stem) in basilar artery occlusion. Stroke 2012; 43 (11): 3003–3006. doi: 10.1161/STROKEAHA.112.666867.

22. Dargazanli C, Consoli A, Gory B et al. Is reperfusion useful in ischaemic stroke patients presenting with a low National Institutes of Health Stroke Scale and a proximal large vessel occlusion of the anterior circulation? Cerebrovasc Dis 2017; 43 (5–6): 305–312. doi: 10.1159/000468995.

23. Ota T, Nishiyama Y, Koizumi S et al. Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large--vessel occlusion. Interv Neuroradiol 2018; 24 (2): 162–167. doi: 10.1177/1591019917747247.

24. Rentzos A, Karlsson JE, Lundqvist C et al. Endovascular treatment of acute ischemic stroke in the posterior circulation. Interv Neuroradiol 2018; 24 (4): 405–411. doi: 10.1177/1591019918762320.

25. Jahan R, Saver JL, Schwamm LH et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice. JAMA 2019; 322 (3): 252–263. doi: 10.1001/jama.2019.8286.

26. Tsivgoulis G, Saqqur M, Sharma VK et al. Timing of recanalization and functional recovery in acute ischemic stroke. J Stroke 2020; 22 (1): 130–140. doi: 10.5853/ jos.2019.01648.

27. Fuhrer H, Forner L, Pruellage P et al. Long-term outcome changes after mechanical thrombectomy for anterior circulation acute ischemic stroke. J Neurol 2020; 267 (4): 1026–1034. doi: 10.1007/s00415-019-09670-w.

28. Fonarow GC, Smith EE, Saver JL et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011; 123 (7): 750–758. doi: 10.1161/CIRCULATIONAHA.110.974675.

29. Ebinger M, Kunz A, Wendt M et al. Effects of golden hour thrombolysis: a prehospital acute neurological treatment and optimization of medical care in stroke (PHANTOM-S) substudy. JAMA Neurol 2015; 72 (1): 25–30. doi: 10.1001/jamaneurol.2014.3188.

30. Jung S, Rosini JM, Nomura JT et al. Even faster door-to-alteplase times and associated outcomes in acute ischemic stroke. J Stroke Cerebrovasc Dis 2019; 28 (12): 104329. doi: 10.1016/j.jstrokecerebrovasdis.2019.104 329.

31. Bush CK, Kurimella D, Cross LJ et al. Endovascular treatment with stent-retriever devices for acute ischemic stroke: a meta-analysis of randomized controlled trials. PLoS One 2016; 11 (1): e0147287. doi: 10.1371/journal.pone.0147287.

32. Skagen K, Skjelland M, Russell D et al. Large-vessel occlusion stroke: effect of recanalization on outcome depends on the National Institutes of Health Stroke Scale score. J Stroke Cerebrovasc Dis 2015; 24 (7): 1532–1539. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.020.