http://stroke.ahajournals.org/content/early/2015/03/19/STROKEAHA.115.009012.abstract?papetoc
Prospective 5-Year Study and Comprehensive Meta-Analysis
- Georgios Tsivgoulis, MD,
- Ramin Zand, MD,
- Aristeidis H. Katsanos, MD,
- Nitin Goyal, MD,
- Ken Uchino, MD,
- Jason Chang, MD,
- Efthimios Dardiotis, MD,
- Jukka Putaala, MD,
- Anne W. Alexandrov, PhD,
- Marc D. Malkoff, MD and
- Andrei V. Alexandrov, MD
+ Author Affiliations
- Correspondence to Georgios Tsivgoulis, MD, Second Department of Neurology, University of Athens, School of Medicine, Iras 39, Gerakas Attikis, Athens, Greece 15344. E-mail tsivgoulisgiorg@yahoo.gr
Abstract
Background and Purpose—Shortening
door-to-needle time may lead to inadvertent intravenous thrombolysis
(IVT) administration in stroke mimics (SMs).
We sought to determine the safety of IVT in
SMs using prospective, single-center data and by conducting a
comprehensive meta-analysis
of reported case-series.
Methods—We
prospectively analyzed consecutive IVT-treated patients during a 5-year
period at a tertiary care stroke center. A systematic
review and meta-analysis of case-series
reporting safety of IVT in SMs and confirmed acute ischemic stroke were
conducted.
Symptomatic intracerebral hemorrhage was
defined as imaging evidence of ICH with an National Institutes of Health
Stroke scale
increase of ≥4 points. Favorable functional
outcome at hospital discharge was defined as a modified Rankin Scale
score of
0 to 1.
Results—Of 516
consecutive IVT patients at our tertiary care center (50% men; mean age,
60±14 years; median National Institutes of
Health Stroke scale, 11; range, 3–22), SMs
comprised 75 cases.(A 14.5% failure rate!!!) Symptomatic intracerebral hemorrhage occurred in 1
patient,
whereas we documented no cases of orolingual
edema or major extracranial hemorrhagic complications. In meta-analysis
of 9
studies (8942 IVT-treated patients), the
pooled rates of symptomatic intracerebral hemorrhage and orolingual
edema among 392
patients with SM treated with IVT were 0.5%
(95% confidence interval, 0%–2%) and 0.3% (95% confidence interval,
0%–2%), respectively.
Patients with SM were found to have a
significantly lower risk for symptomatic intracerebral hemorrhage
compared with patients
with acute ischemic stroke (risk ratio=0.33;
95% confidence interval, 0.14–0.77; P=0.010), with no evidence
of heterogeneity or publication bias. Favorable functional outcome was
almost 3-fold higher in patients
with SM in comparison with patients with
acute ischemic stroke (risk ratio=2.78; 95% confidence interval,
2.07–3.73; P<0.00001).
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