Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
-
J Stroke Cerebrovasc Dis · Jan 2014
Observational StudyTissue plasminogen activator overdose in acute ischemic stroke patients linked to poorer functional outcomes.
The dose of intravenous tissue plasminogen activator (tPA) administered in acute ischemic stroke patients is calculated using the patient's weight (0.9 mg/kg). Patients are rarely weighed before treatment in actual practice, although overestimating patient weights leads to higher doses of tPA, which may adversely influence outcome. ⋯ Our findings provide support for the practice of accurately weighing all acute ischemic stroke patients before thrombolysis.
-
J Stroke Cerebrovasc Dis · Jan 2014
Predictors of in-hospital mortality and the risk of symptomatic intracerebral hemorrhage after thrombolytic therapy with recombinant tissue plasminogen activator in acute ischemic stroke.
Recombinant tissue-plasminogen activator (rt-PA) therapy improves functional outcome in patients with acute ischemic stroke (AIS) but is associated with serious complications, including symptomatic intracerebral hemorrhage (sICH). This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sICH after rt-PA therapy. A total of 1007 patients (mean age, 72 ± 12 years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, 11.6 ± 5.6) with AIS treated with rt-PA were enrolled in this study during a 42-month period beginning in November 2007. ⋯ After rt-PA therapy, 58 patients (5.8%) sustained sICH, 16 (28%) of whom died. Increased age (P = .008), higher NIHSS score (P = .011), and atrial fibrillation (P = .025) were correlated with sICH. The findings from this study may help clinicians estimate the prognosis and risk of sICH in patients with AIS treated with rt-PA.
-
J Stroke Cerebrovasc Dis · Jan 2014
Internal cerebral vein asymmetry on follow-up brain computed tomography after intravenous thrombolysis in acute anterior circulation ischemic stroke is associated with poor outcome.
Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. ⋯ ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.
-
J Stroke Cerebrovasc Dis · Jan 2014
Race and income disparity in ischemic stroke care: nationwide inpatient sample database, 2002 to 2008.
Health care disparities exist between demographic groups with stroke. We examined whether patients of particular ethnicity or income levels experienced reduced access to or delays in receiving stroke care. ⋯ African Americans, Hispanics, and low median income patients are less likely to receive i.v. thrombolysis for ischemic stroke. Low median income patients are less likely to be treated at high-volume hospitals. High-volume hospitals have lower mortality rates and a higher likelihood of treating patients with i.v. thrombolysis. There is evidence for an influence of socioeconomic status and racial disparity in the treatment of ischemic stroke.
-
J Stroke Cerebrovasc Dis · Jan 2014
Early neurologic improvement based on the National Institutes of Health Stroke Scale score predicts favorable outcome within 30 minutes after undergoing intravenous recombinant tissue plasminogen activator therapy.
The aim of the present study was to evaluate whether early neurologic improvement (within 30 minutes), as measured using the National Institutes of Health Stroke Scale (NIHSS) score, predicts favorable outcome at 90 days. ⋯ An improvement of at least 3 points in the NIHSS score at 15 minutes or of at least 5 points at 30 minutes appears to be a predictor of favorable outcome and helps to identify patients who will not respond to rt-PA therapy.