Timing of Recanalization and Functional Recovery in Acute
Ischemic Stroke

J 2020

Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

TSIVGOULIS, G., M. SAQQUR, V. K. SHARMA, A. BRUNSER, J. EGGERS et. al.

Basic information

Original name

Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

Authors

TSIVGOULIS, G. (300 Greece), M. SAQQUR (634 Qatar), V. K. SHARMA (702 Singapore), A. BRUNSER (152 Chile), J. EGGERS (276 Germany), Robert MIKULÍK (203 Czech Republic, belonging to the institution), A. H. KATSANOS (300 Greece), T. N. SERGENTANIS (300 Greece), K. VADIKOLIAS (300 Greece), F. PERREN (756 Switzerland), M. RUBIERA (724 Spain), R. B. SHAHRIPOUR (840 United States of America), H. T. NGUYEN (704 Viet Nam), P. MARTINEZ-SANCHEZ (724 Spain), A. SAFOURIS (300 Greece), I. HELIOPOULOS (300 Greece), A. SHUAIB (124 Canada), C. DERKSEN (124 Canada), K. VOUMVOURAKIS (300 Greece), T. PSALTOPOULOU (300 Greece), A. W. ALEXANDROV (840 United States of America) and A. V. ALEXANDROV (840 United States of America, guarantor)

Edition

JOURNAL OF STROKE, SEOUL, KOREAN STROKE SOC, 2020, 2287-6391

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

Republic of Korea

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 6.967

RIV identification code

RIV/00216224:14110/20:00116219

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.5853/jos.2019.01648

UT WoS

000512366600011

Keywords in English

Thrombolysis; Stroke; Reperfusion; Outcomes

Abstract

V originále

Background and Purpose Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. Methods We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FF0) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. Results We enrolled 480 AIS patients (mean age 66 +/- 15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53% vs 10%) had significantly (P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28 %) and F1 (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [011], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). Conclusions Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.

Links

LM2018128, research and development project

Name: Český národní uzel Evropské sítě infrastruktur klinického výzkumu (Acronym: CZECRIN)

Investor: Ministry of Education, Youth and Sports of the CR

Citovat

TSIVGOULIS, G., M. SAQQUR, V. K. SHARMA, A. BRUNSER, J. EGGERS, Robert MIKULÍK, A. H. KATSANOS, T. N. SERGENTANIS, K. VADIKOLIAS, F. PERREN, M. RUBIERA, R. B. SHAHRIPOUR, H. T. NGUYEN, P. MARTINEZ-SANCHEZ, A. SAFOURIS, I. HELIOPOULOS, A. SHUAIB, C. DERKSEN, K. VOUMVOURAKIS, T. PSALTOPOULOU, A. W. ALEXANDROV and A. V. ALEXANDROV. Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke. JOURNAL OF STROKE. SEOUL: KOREAN STROKE SOC, 2020, vol. 22, No 1, p. „130-140+1“-„9“, 20 pp. ISSN 2287-6391. Available from: https://dx.doi.org/10.5853/jos.2019.01648.

@article{1674500,
   author = {Tsivgoulis, G. and Saqqur, M. and Sharma, V. K. and Brunser, A. and Eggers, J. and Mikulík, Robert and Katsanos, A. H. and Sergentanis, T. N. and Vadikolias, K. and Perren, F. and Rubiera, M. and Shahripour, R. B. and Nguyen, H. T. and MartinezandSanchez, P. and Safouris, A. and Heliopoulos, I. and Shuaib, A. and Derksen, C. and Voumvourakis, K. and Psaltopoulou, T. and Alexandrov, A. W. and Alexandrov, A. V.},
   article_location = {SEOUL},
   article_number = {1},
   doi = {http://dx.doi.org/10.5853/jos.2019.01648},
   keywords = {Thrombolysis; Stroke; Reperfusion; Outcomes},
   language = {eng},
   issn = {2287-6391},
   journal = {JOURNAL OF STROKE},
   title = {Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke},
   url = {https://www.j-stroke.org/upload/pdf/jos-2019-01648.pdf},
   volume = {22},
   year = {2020}
}

TY  - JOUR
ID  - 1674500
AU  - Tsivgoulis, G. - Saqqur, M. - Sharma, V. K. - Brunser, A. - Eggers, J. - Mikulík, Robert - Katsanos, A. H. - Sergentanis, T. N. - Vadikolias, K. - Perren, F. - Rubiera, M. - Shahripour, R. B. - Nguyen, H. T. - Martinez-Sanchez, P. - Safouris, A. - Heliopoulos, I. - Shuaib, A. - Derksen, C. - Voumvourakis, K. - Psaltopoulou, T. - Alexandrov, A. W. - Alexandrov, A. V.
PY  - 2020
TI  - Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
JF  - JOURNAL OF STROKE
VL  - 22
IS  - 1
SP  - „130-140+1“-„9“
EP  - „130-140+1“-„9“
PB  - KOREAN STROKE SOC
SN  - 22876391
KW  - Thrombolysis
KW  - Stroke
KW  - Reperfusion
KW  - Outcomes
UR  - https://www.j-stroke.org/upload/pdf/jos-2019-01648.pdf
L2  - https://www.j-stroke.org/upload/pdf/jos-2019-01648.pdf
N2  - Background and Purpose Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. Methods We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FF0) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. Results We enrolled 480 AIS patients (mean age 66 +/- 15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53% vs 10%) had significantly (P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28 %) and F1 (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [011], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). Conclusions Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time results in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.
ER  -

TSIVGOULIS, G., M. SAQQUR, V. K. SHARMA, A. BRUNSER, J. EGGERS, Robert MIKULÍK, A. H. KATSANOS, T. N. SERGENTANIS, K. VADIKOLIAS, F. PERREN, M. RUBIERA, R. B. SHAHRIPOUR, H. T. NGUYEN, P. MARTINEZ-SANCHEZ, A. SAFOURIS, I. HELIOPOULOS, A. SHUAIB, C. DERKSEN, K. VOUMVOURAKIS, T. PSALTOPOULOU, A. W. ALEXANDROV and A. V. ALEXANDROV. Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke. \textit{JOURNAL OF STROKE}. SEOUL: KOREAN STROKE SOC, 2020, vol.~22, No~1, p.~„130-140+1“-„9“, 20 pp. ISSN~2287-6391. Available from: https://dx.doi.org/10.5853/jos.2019.01648.

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