Cerebral ischaemia with unknown onset: Outcome after recanalization procedure.
In: Revue neurologique, Jg. 176 (2020), Heft 1-2, S. 75-84
academicJournal
Zugriff:
Background: Stroke of unknown time of onset (UTOS) accounts for one-third of contra-indications for revascularization procedures. With modern neuroimaging techniques it is possible to differentiate the core infarcts and the presence of penumbra.
Objective: To evaluate outcomes in patients with UTOS, treated with intravenous (i.v.) recombinant tissue-plasminogen activator (rt-PA), mechanical thrombectomy (MT), or both.
Method: We conducted this observational study in patients treated by i.v. rt-PA, MT, or both, selected by a diffusion-weighted image/fluid-attenuated inversion recovery mismatch. We evaluated outcomes with the modified Rankin scale (mRS) at 3 months.
Results: Of 992 consecutive patients (522 women, 52.6%; median age 76 years; median baseline national institutes of health stroke scale [NIHSS] 10), 153 (15.4%) had UTOS, including 101 with wake-up strokes. Compared to other patients, they were more likely to have pre-existing mRS scores >2 (P=0.022), multiple infarcts (P<0.001), middle cerebral artery occlusions (P=0.023), and to undergo MT (P=0.003), and less likely to receive i.v. rt-PA (P<0.001). They had higher NIHSS scores (P<0.001) and longer discovery to treatment initiation times (P<0.001). They were more likely to develop pulmonary (P=0.001) and urinary (P=0.006) infections, and pulmonary embolism (P=0.019), and tended to have a higher mortality rate (P=0.052) within 7 days. After adjustment, there was no association of UTOS with any of these outcome measures anymore.
Conclusion: Patients with UTOS have more severe strokes and more comorbidities, but after adjustment, their outcomes did not differ from those of other patients.
(Copyright © 2019 Elsevier Masson SAS. All rights reserved.)
Titel: |
Cerebral ischaemia with unknown onset: Outcome after recanalization procedure.
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Autor/in / Beteiligte Person: | Tortuyaux, R ; Ferrigno, M ; Dequatre-Ponchelle, N ; Djelad, S ; Cordonnier, C ; Hénon, H ; Leys, D |
Zeitschrift: | Revue neurologique, Jg. 176 (2020), Heft 1-2, S. 75-84 |
Veröffentlichung: | Paris : Masson ; <i>Original Publication</i>: Paris., 2020 |
Medientyp: | academicJournal |
ISSN: | 0035-3787 (print) |
DOI: | 10.1016/j.neurol.2019.05.004 |
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