Document Detail


Good clinical outcome after ischemic stroke with successful revascularization is time-dependent.
MedLine Citation:
PMID:  19786699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Trials of IV recombinant tissue plasminogen activator (rt-PA) have demonstrated that longer times from ischemic stroke symptom onset to initiation of treatment are associated with progressively lower likelihoods of clinical benefit, and likely no benefit beyond 4.5 hours. How the timing of IV rt-PA initiation relates to timing of restoration of blood flow has been unclear. An understanding of the relationship between timing of angiographic reperfusion and clinical outcome is needed to establish time parameters for intraarterial (IA) therapies.
METHODS: The Interventional Management of Stroke pilot trials tested combined IV/IA therapy for moderate-to-severe ischemic strokes within 3 hours from symptom onset. To isolate the effect of time to angiographic reperfusion on clinical outcome, we analyzed only middle cerebral artery and distal internal carotid artery occlusions with successful reperfusion (Thrombolysis in Cerebral Infarction 2-3) during the interventional procedure (<7 hours). Time to angiographic reperfusion was defined as time from stroke onset to procedure termination. Good clinical outcome was defined as modified Rankin Score 0-2 at 3 months.
RESULTS: Among the 54 cases, only time to angiographic reperfusion and age independently predicted good clinical outcome after angiographic reperfusion. The probability of good clinical outcome decreased as time to angiographic reperfusion increased (unadjusted p = 0.02, adjusted p = 0.01) and approached that of cases without angiographic reperfusion within 7 hours.
CONCLUSIONS: We provide evidence that good clinical outcome following angiographically successful reperfusion is significantly time-dependent. At later times, angiographic reperfusion may be associated with a poor risk-benefit ratio in unselected patients.
Authors:
P Khatri; T Abruzzo; S D Yeatts; C Nichols; J P Broderick; T A Tomsick;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  73     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-29     Completed Date:  2009-10-21     Revised Date:  2014-09-20    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1066-72     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Brain Ischemia / drug therapy*,  radiography
Carotid Stenosis / drug therapy,  radiography
Cerebral Angiography
Cerebral Revascularization / methods*
Female
Fibrinolytic Agents / administration & dosage*
Humans
Infarction, Middle Cerebral Artery / drug therapy*,  radiography
Injections, Intra-Arterial
Injections, Intravenous
Male
Middle Aged
Pilot Projects
Severity of Illness Index
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
K23 NS059843/NS/NINDS NIH HHS; K23 NS059843/NS/NINDS NIH HHS; K23 NS059843-02/NS/NINDS NIH HHS; R01 NS039160/NS/NINDS NIH HHS; R01 NS039160-03/NS/NINDS NIH HHS; R01NS39160/NS/NINDS NIH HHS; R44 HL064434-03/HL/NHLBI NIH HHS; R44HL64434/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator
Investigator
Investigator/Affiliation:
Judith Spilker / ; Janice A Carrozzella / ; Michael D Hill / ; Karla Ryckborst / ; Andrew Demchuk / ; Yuko Palesch / ; Renee Martin / ; Gowri Ramadas /
Comments/Corrections

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