Document Detail


MRI-based intravenous thrombolysis in stroke patients with unknown time of symptom onset.
MedLine Citation:
PMID:  21895879     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:  Currently, stroke patients with unknown time of symptom onset (UTOS) are excluded from therapy with intravenous tissue Plasminogen Activator. We hypothesized that MRI-based intravenous thrombolysis is safe in UTOS. Methods:  We analyzed radiological and clinical data as well as outcomes of stroke patients (including UTOS) who received intravenous thrombolytic therapy after MRI. Results:  Compared to patients with known time of symptom onset (n = 131), UTOS (n = 17) were older (81, 71-88 vs. 75 years, 66-82, P = 0.03), had a longer median time between last-seen-well and thrombolysis (12.3 h, IQR 11.5-15.2 h vs. 2.1 h, 1.8-2.8 h, P < 0.01), had a longer median door-to-needle time (86 min, 49-112 vs. 60 min, 49-76, P = 0.02), and a higher rate of arterial obstruction on MR-angiography (82.4% vs. 56.5%, P = 0.04). No symptomatic intracerebral hemorrhage occurred in UTOS. After 3 months, there was no significant difference between groups concerning good functional outcome (modified Rankin Scale 0-2; 35.3% vs. 49.6%, P = 0.26) or mortality (0% vs. 15.3%, P = 0.08). In multivariate analyses including age, gender, baseline NIHSS, and atrial fibrillation UTOS did not have an independent effect on good functional outcome after 3 months (OR 1.16; 0.32-4.12, P = 0.81). Conclusions:  Thrombolysis after MRI seems safe and effective in UTOS. This observation may encourage those who plan prospective placebo-controlled trials of thrombolytics in this subgroup of stroke patients.
Authors:
M Ebinger; J F Scheitz; A Kufner; M Endres; J B Fiebach; C H Nolte
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-6
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  -     ISSN:  1468-1331     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Author(s). European Journal of Neurology © 2011 EFNS.
Affiliation:
Center for Stroke Research Berlin (CSB), Charitéplatz, Berlin Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Campus Charité Mitte and Campus Benjamin Franklin, Berlin International Graduate Program Medical Neurosciences, Charité- Universitätsmedizin Berlin, Luisenstrasse, Berlin, Germany.
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