Addressing a real‐life problem: treatment with intravenous thrombolysis and mechanical thrombectomy in acute stroke patients with an extended time window beyond 4.5 h based on computed tomography perfusion imaging
| العنوان: | Addressing a real‐life problem: treatment with intravenous thrombolysis and mechanical thrombectomy in acute stroke patients with an extended time window beyond 4.5 h based on computed tomography perfusion imaging |
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| المؤلفون: | Thomas Liebig, Lars Kellert, Jonathan Vöglein, Wolfgang G. Kunz, Marianne Dieterich, Johanna Heinrich, Paul Reidler, Christoph Laub, Katharina Müller, Clemens Küpper, Katharina Feil |
| المصدر: | European journal of neurology 27(1), 168-174 (2019). doi:10.1111/ene.14051 |
| بيانات النشر: | Wiley, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | therapy [Stroke], Male, medicine.medical_treatment, 0302 clinical medicine, methods [Thrombectomy], Interquartile range, Modified Rankin Scale, administration & dosage [Fibrinolytic Agents], therapeutic use [Fibrinolytic Agents], diagnostic imaging [Stroke], Computed Tomography Perfusion Imaging, 030212 general & internal medicine, Stroke, Thrombectomy, Aged, 80 and over, medicine.diagnostic_test, Thrombolysis, Middle Aged, Magnetic Resonance Imaging, diagnostic imaging [Intracranial Hemorrhages], surgery [Stroke], Treatment Outcome, Neurology, Cerebral blood flow, Cerebrovascular Circulation, Cardiology, Administration, Intravenous, Female, Intracranial Hemorrhages, Brain Infarction, medicine.medical_specialty, Perfusion Imaging, diagnostic imaging [Brain Infarction], Time-to-Treatment, 03 medical and health sciences, Fibrinolytic Agents, Internal medicine, medicine, Humans, ddc:610, Aged, Intracerebral hemorrhage, business.industry, Magnetic resonance imaging, medicine.disease, Neurology (clinical), Tomography, X-Ray Computed, business, 030217 neurology & neurosurgery |
| الوصف: | Background and purpose Acute ischemic stroke treatment with intravenous thrombolysis (IVT) is restricted to a time window of 4.5 h after known or presumed onset. Recently, magnetic resonance imaging-guided treatment decision-making in wake-up stroke (WUS) was shown to be effective. The aim of this study was to determine the safety and outcome of IVT in patients with a time window beyond 4.5 h selected by computed tomography perfusion (CTP) imaging. Methods We analyzed all consecutive patients last seen well beyond 4.5 h after stroke onset treated with IVT based on CTP between January 2015 and October 2018. CTP was visually assessed to estimate the mismatch between cerebral blood flow and cerebral blood volume maps. Early infarct signs were documented according to Alberta Stroke Program Early CT Score (ASPECTS). Safety data were obtained for mortality and symptomatic intracerebral hemorrhage (sICH). Follow-up was assessed with the modified Rankin Scale (mRS). Results A total of 70 patients fulfilled the inclusion criteria (mean age ± SD 77.6 ± 11.5 years, 50.0% female). Median National Institutes of Health Stroke Scale score on admission was 8.0 [interquartile range (IQR), 4-14]. The most frequent reasons for an extended time window were WUS (60.0%) and delayed hospital admission (27.1%). Median time from last seen well to IVT was 11.4 h. Median ASPECTS was 10 (IQR, 9-10) and CTP mismatch 90% (IQR, 80%-100%). A total of 24 patients (34.3%) underwent additional mechanical thrombectomy. sICH occurred in four patients (5.7%). At follow-up, 49.3% had an mRS score of 0-2 and 22.4% had an mRS score of 0-1. Conclusions In patients presenting in an extended time window beyond 4.5 h, IVT treatment with decision-making based on CTP might be a safe procedure. Further evaluation in clinical trials is needed. |
| وصف الملف: | application/pdf |
| تدمد: | 1468-1331 1351-5101 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::423a1374498c30eef6789a0638e80d5dTest https://doi.org/10.1111/ene.14051Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....423a1374498c30eef6789a0638e80d5d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14681331 13515101 |
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