Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke

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. We conducted a multicenter...

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Autores: Tsivgoulis, Georgios|||0000-0002-0640-3797, Saqqur, Maher, Sharma, Vijay K., Brunser, Alejandro, Eggers, Jürgen, Mikulik, Robert, Katsanos, Aristeidis H.|||0000-0002-6359-0023, Sergentanis, Theodore N., Vadikolias, Konstantinos, Perren, Fabienne, Rubiera Del Fueyo, Marta A.|||0000-0001-8100-9477, Bavarsad Shahripour, Reza, Nguyen, Huy Thang, Martínez-Sánchez, Patricia, Safouris, Apostolos, Heliopoulos, Ioannis, Shuaib, Ashfaq, Derksen, Carol, Voumvourakis, Konstantinos I., Psaltopoulou, Theodora, Alexandrov, Andrei V.|||0000-0001-8871-1023
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:226246
Acceso en línea:https://ddd.uab.cat/record/226246
https://dx.doi.org/urn:doi:10.5853/jos.2019.01648
Access Level:acceso abierto
Palabra clave:Thrombolysis
Stroke
Reperfusion
Outcomes
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spelling Timing of Recanalization and Functional Recovery in Acute Ischemic StrokeTsivgoulis, Georgios|||0000-0002-0640-3797Saqqur, MaherSharma, Vijay K.Brunser, AlejandroEggers, JürgenMikulik, RobertKatsanos, Aristeidis H.|||0000-0002-6359-0023Sergentanis, Theodore N.Vadikolias, KonstantinosPerren, FabienneRubiera Del Fueyo, Marta A.|||0000-0001-8100-9477Bavarsad Shahripour, RezaNguyen, Huy ThangMartínez-Sánchez, PatriciaSafouris, ApostolosHeliopoulos, IoannisShuaib, AshfaqDerksen, CarolVoumvourakis, Konstantinos I.Psaltopoulou, TheodoraAlexandrov, Andrei V.|||0000-0001-8871-1023Alexandrov, Andrei V.|||0000-0001-8871-1023ThrombolysisStrokeReperfusionOutcomesAlthough 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. 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 (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. 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%) had significantly (jos-2019-01648 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 FI (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 [OR], 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). 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.Universitat Autònoma de Barcelona 22020-01-0120202020-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/226246https://dx.doi.org/urn:doi:10.5853/jos.2019.01648reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2262462026-06-06T12:50:31Z
dc.title.none.fl_str_mv Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
spellingShingle Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
Tsivgoulis, Georgios|||0000-0002-0640-3797
Thrombolysis
Stroke
Reperfusion
Outcomes
title_short Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_full Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_fullStr Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_full_unstemmed Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
title_sort Timing of Recanalization and Functional Recovery in Acute Ischemic Stroke
dc.creator.none.fl_str_mv Tsivgoulis, Georgios|||0000-0002-0640-3797
Saqqur, Maher
Sharma, Vijay K.
Brunser, Alejandro
Eggers, Jürgen
Mikulik, Robert
Katsanos, Aristeidis H.|||0000-0002-6359-0023
Sergentanis, Theodore N.
Vadikolias, Konstantinos
Perren, Fabienne
Rubiera Del Fueyo, Marta A.|||0000-0001-8100-9477
Bavarsad Shahripour, Reza
Nguyen, Huy Thang
Martínez-Sánchez, Patricia
Safouris, Apostolos
Heliopoulos, Ioannis
Shuaib, Ashfaq
Derksen, Carol
Voumvourakis, Konstantinos I.
Psaltopoulou, Theodora
Alexandrov, Andrei V.|||0000-0001-8871-1023
Alexandrov, Andrei V.|||0000-0001-8871-1023
author Tsivgoulis, Georgios|||0000-0002-0640-3797
author_facet Tsivgoulis, Georgios|||0000-0002-0640-3797
Saqqur, Maher
Sharma, Vijay K.
Brunser, Alejandro
Eggers, Jürgen
Mikulik, Robert
Katsanos, Aristeidis H.|||0000-0002-6359-0023
Sergentanis, Theodore N.
Vadikolias, Konstantinos
Perren, Fabienne
Rubiera Del Fueyo, Marta A.|||0000-0001-8100-9477
Bavarsad Shahripour, Reza
Nguyen, Huy Thang
Martínez-Sánchez, Patricia
Safouris, Apostolos
Heliopoulos, Ioannis
Shuaib, Ashfaq
Derksen, Carol
Voumvourakis, Konstantinos I.
Psaltopoulou, Theodora
Alexandrov, Andrei V.|||0000-0001-8871-1023
author_role author
author2 Saqqur, Maher
Sharma, Vijay K.
Brunser, Alejandro
Eggers, Jürgen
Mikulik, Robert
Katsanos, Aristeidis H.|||0000-0002-6359-0023
Sergentanis, Theodore N.
Vadikolias, Konstantinos
Perren, Fabienne
Rubiera Del Fueyo, Marta A.|||0000-0001-8100-9477
Bavarsad Shahripour, Reza
Nguyen, Huy Thang
Martínez-Sánchez, Patricia
Safouris, Apostolos
Heliopoulos, Ioannis
Shuaib, Ashfaq
Derksen, Carol
Voumvourakis, Konstantinos I.
Psaltopoulou, Theodora
Alexandrov, Andrei V.|||0000-0001-8871-1023
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Thrombolysis
Stroke
Reperfusion
Outcomes
topic Thrombolysis
Stroke
Reperfusion
Outcomes
description 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. 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 (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. 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%) had significantly (jos-2019-01648 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 FI (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 [OR], 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). 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.
publishDate 2020
dc.date.none.fl_str_mv 2
2020-01-01
2020
2020-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/226246
https://dx.doi.org/urn:doi:10.5853/jos.2019.01648
url https://ddd.uab.cat/record/226246
https://dx.doi.org/urn:doi:10.5853/jos.2019.01648
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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