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Ultraearly repeated systemic thrombolysis in recurrent ischemic stroke - A multicentre case study

T. Etgen, M. Cappellari, D. Černík, R. Topakian, LA. Sposato, P. Sardag, H. Wiestler

. 2023 ; 451 (-) : 120714. [pub] 20230615

Jazyk angličtina Země Nizozemsko

Typ dokumentu multicentrická studie, časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc23016568

OBJECTIVE: We analysed outcomes of patients who received off-label repeated thrombolysis with recombinant tissue plasminogen activator for ischemic stroke recurrence within 10 days (ultraearly repeated thrombolysis, UERT). METHOD: We identified patients receiving UERT from the prospective telestroke network of South-East Bavaria (TEMPiS) registry and by database search (Pubmed, Google scholar). Corresponding authors were contacted for further details. Baseline demographic data and clinical, laboratory, and imaging findings were analysed in a multicentric case study. RESULTS: Sixteen patients receiving UERT were identified. The median time between first and second thrombolysis was 3.5 days. In patients with available data, second thrombolysis achieved an early clinical improvement (NIHSS reduction ≥4 points) in 12 of 14 (85.7%) and a favourable outcome (mRS 0-2 after 3 months) in 11 of 16 (68.8%) patients. Intracerebral haemorrhage (ICH) occurred in 4 patients (25.0%) with one fatal large parenchymatous haemorrhage (6.3%). Neither allergic reactions nor other immunoreactive events were observed. CONCLUSIONS: In our analysis UERT led to early clinical improvement and a favourable clinical outcome in a high percentage of patients with ICH rates comparable to prior publications. UERT might be considered in patients with early recurrent stroke under careful risk-benefit assessment.

Citace poskytuje Crossref.org

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$a Etgen, Thorleif $u Klinik für Neurologie, Klinikum Traunstein, Germany; Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany. Electronic address: thorleif.etgen@kliniken-sob.de
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$a OBJECTIVE: We analysed outcomes of patients who received off-label repeated thrombolysis with recombinant tissue plasminogen activator for ischemic stroke recurrence within 10 days (ultraearly repeated thrombolysis, UERT). METHOD: We identified patients receiving UERT from the prospective telestroke network of South-East Bavaria (TEMPiS) registry and by database search (Pubmed, Google scholar). Corresponding authors were contacted for further details. Baseline demographic data and clinical, laboratory, and imaging findings were analysed in a multicentric case study. RESULTS: Sixteen patients receiving UERT were identified. The median time between first and second thrombolysis was 3.5 days. In patients with available data, second thrombolysis achieved an early clinical improvement (NIHSS reduction ≥4 points) in 12 of 14 (85.7%) and a favourable outcome (mRS 0-2 after 3 months) in 11 of 16 (68.8%) patients. Intracerebral haemorrhage (ICH) occurred in 4 patients (25.0%) with one fatal large parenchymatous haemorrhage (6.3%). Neither allergic reactions nor other immunoreactive events were observed. CONCLUSIONS: In our analysis UERT led to early clinical improvement and a favourable clinical outcome in a high percentage of patients with ICH rates comparable to prior publications. UERT might be considered in patients with early recurrent stroke under careful risk-benefit assessment.
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$a Cappellari, Manuel $u Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Italy
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$a Topakian, Raffi $u Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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$a Sposato, Luciano A $u Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, Anatomy and Cell Biology, Robarts Research Institute, Lawson Health Research Institute, Heart & Brain Lab, Western University, London, ON, Canada
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$a Sardag, Philippe $u Helios Klinikum München West, Klinik für Neurologie und Neurogeriatrie, München, Germany
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