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Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study
Author(s) -
Ajili N.,
Decroix J. P.,
Preda C.,
Labreuche J.,
Lopez D.,
Bejot Y.,
Michel P.,
SévinAllouet M.,
Sibon I.,
Vergnet S.,
Wang A.,
Sanda N.,
Mazighi M.,
Bourdain F.,
Lapergue B.
Publication year - 2016
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13042
Subject(s) - medicine , thrombolysis , modified rankin scale , odds ratio , confidence interval , occlusion , stroke (engine) , observational study , randomized controlled trial , tissue plasminogen activator , fibrinolytic agent , surgery , ischemic stroke , ischemia , mechanical engineering , myocardial infarction , engineering
Background and purpose The impact of intravenous recombinant tissue plasminogen activator (IV‐rt PA ) in patients with acute ischaemic stroke ( AIS ) but no arterial occlusion is currently a matter of debate. This study aimed to assess functional outcome of such patients with respect to IV ‐rt PA use. Methods A retrospective case−control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV ‐rt PA use. Patients were selected from prospective consecutive observational registries of five European university hospitals. The primary study outcome was excellent outcome at 3 months after stroke, as defined by a modified Rankin Scale ( mRS ) 0–1. Results A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV ‐rt PA and 188 did not. No between‐group difference was found for excellent outcome before and after adjustment for baseline characteristics (adjusted odds ratio for no IV ‐rt PA use 0.79, 95% confidence interval 0.51–1.24, P = 0.31). Similar results were found for favourable outcome (defined as a 90‐day mRS of 0–2) whereas a higher rate of early neurological improvement was found in IV ‐rt PA ‐treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29–3.07, P = 0.002). Sensitivity analyses yielded similar results. Conclusions Our study suggests that AIS patients without visible arterial occlusion treated with IV ‐rt PA may have no better outcome at 3 months than those untreated. However, only a randomized controlled trial would provide a definitive answer about the impact of rt PA in acute stroke patients without occlusion. Until then, these patients should be treated by rt PA as recommended.