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Salsano G, Pracucci G, Mavilio N, Saia V, Bandettini di Poggio M, Malfatto L, Sallustio F, Wlderk A, Limbucci N, Nencini P, Vallone S, Zini A, Bigliardi G, Velo M, Francalanza I, Gennari P, Tassi R, Bergui M, Cerrato P, Carità G, Azzini C, Gasparotti R, Magoni M, Isceri S, Commodaro C, Cordici F, Menozzi R, Latte L, Cosottini M, Mancuso M, Comai A, Franchini E, Alexandre A, Marca GD, Puglielli E, Casalena A, Causin F, Baracchini C, Di Maggio L, Naldi A, Grazioli A, Forlivesi S, Chiumarulo L, Petruzzellis M, Sanfilippo G, Toscano G, Cavasin N, Adriana C, Ganimede MP, Prontera MP, Giorgianni A, Mauri M, Auteri W, Petrone A, Cirelli C, Falcou A, Corraine S, Piras V, Ganci G, Tassinari T, Nuzzi NP, Corato M, Sacco S, Squassina G, Invernizzi P, Gallesio I, Ferrandi D, Dui G, Deiana G, Amistà P, Russo M, Pintus F, Baule A, Craparo G, Mannino M, Castellan L, Toni D, Mangiafico S. Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke. Int J Stroke 2020; 16:818-827. [PMID: 33283685 DOI: 10.1177/1747493020976681] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
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Affiliation(s)
- Giancarlo Salsano
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Nicola Mavilio
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Valentina Saia
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Monica Bandettini di Poggio
- IRCCS San Martino Policlinic Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy
| | - Laura Malfatto
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Fabrizio Sallustio
- Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy
| | - Andrea Wlderk
- Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Stefano Vallone
- Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy
| | - Mariano Velo
- Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy
| | - Isabella Francalanza
- Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy
| | - Paola Gennari
- Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy
| | - Rossana Tassi
- Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Giuseppe Carità
- Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Cristiano Azzini
- Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | - Mauro Magoni
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Salvatore Isceri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Christian Commodaro
- Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy
| | - Francesco Cordici
- Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy
| | - Roberto Menozzi
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy
| | - Lilia Latte
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Alessio Comai
- Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy
| | - Enrica Franchini
- Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy
| | - Andrea Alexandre
- Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giacomo Della Marca
- Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | | | - Francesco Causin
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | - Luca Di Maggio
- Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Grazioli
- UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Forlivesi
- UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy
| | - Marco Petruzzellis
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy
| | - Giuseppina Sanfilippo
- Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy
| | - Gianpaolo Toscano
- Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy
| | - Nicola Cavasin
- Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Critelli Adriana
- Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Maria Porzia Ganimede
- Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy
| | - Maria Pia Prontera
- Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy
| | - Andrea Giorgianni
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | - William Auteri
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Alfredo Petrone
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Carlo Cirelli
- Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Anne Falcou
- Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Simona Corraine
- Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy
| | - Valeria Piras
- Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy
| | - Giuseppe Ganci
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Tiziana Tassinari
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | | | - Manuel Corato
- IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Simona Sacco
- Department of Clinical Scieces and Biotechnology, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Guido Squassina
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Paolo Invernizzi
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Ivan Gallesio
- Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy
| | - Delfina Ferrandi
- Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy
| | - Giovanni Dui
- Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy
| | - Gianluca Deiana
- Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy
| | - Pietro Amistà
- Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy
| | - Monia Russo
- Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy
| | - Francesco Pintus
- Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy
| | - Antonio Baule
- Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy
| | - Giuseppe Craparo
- Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Marina Mannino
- Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Lucio Castellan
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Mangiafico
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
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Cappellari M, Bonetti B, Forlivesi S, Sajeva G, Naccarato M, Caruso P, Lorenzut S, Merlino G, Viaro F, Pieroni A, Giometto B, Bignamini V, Perini F, De Boni A, Morra M, Critelli A, Tamborino C, Tonello S, Guidoni SV, L'Erario R, Russo M, Burlina A, Turinese E, Passadore P, Zanet L, Polo A, Turazzini M, Basile AM, Atzori M, Marini B, Bruno M, Carella S, Campagnaro A, Baldi A, Corazza E, Zanette G, Idone D, Gaudenzi A, Bombardi R, Cadaldini M, Lanzafame S, Ferracci F, Zambito S, Ruzza G, Simonetto M, Menegazzo E, Masato M, Padoan R, Bozzato G, Paladin F, Tonon A, Bovi P. Acute revascularization treatments for ischemic stroke in the Stroke Units of Triveneto, northeast Italy: time to treatment and functional outcomes. J Thromb Thrombolysis 2020; 51:159-167. [PMID: 32424778 DOI: 10.1007/s11239-020-02142-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is not known whether the current territorial organization for acute revascularization treatments in ischemic stroke patients guarantees similar time to treatment and functional outcomes among different levels of institutional stroke care. We aimed to assess the impact of time to treatment on functional outcomes in ischemic stroke patients who received intravenous thrombolysis (IVT) alone, bridging (IVT plus thrombectomy), or primary thrombectomy in level 1 and level 2 Stroke Units (SUs) in Triveneto, a geographical macroarea in Northeast of Italy. We conducted an analysis of data prospectively collected from 512 consecutive ischemic stroke patients who received IVT and/or mechanical thrombectomy in 25 SUs from September 17th to December 9th 2018. The favorable outcome measures were mRS score 0-1 and 0-2 at 3 months. The unfavorable outcome measures were mRS score 3-5 and death at 3 months. We estimated separately the possible association of each variable for time to treatment (onset-to-door, door-to-needle, onset-to-needle, door-to-groin puncture, needle-to-groin puncture, and onset-to-groin puncture) with 3-month outcome measures by calculating the odds ratios (ORs) with two-sided 95% confidence intervals (CI) after adjustment for pre-defined variables and variables with a probability value ≤ 0.10 in the univariate analysis for each outcome measure. Distribution of acute revascularization treatments was different between level 1 and level 2 SUs (p < 0.001). Among 182 patients admitted to level 1 SUs (n = 16), treatments were IVT alone in 164 (90.1%), bridging in 12 (6.6%), and primary thrombectomy in 6 (3.3%) patients. Among 330 patients admitted to level 2 SUs (n = 9), treatments were IVT alone in 219 (66.4%), bridging in 74 (22.4%), and primary thrombectomy in 37 (11.2%) patients. Rates of excellent outcome (51.4% vs 45.9%), favorable outcome (60.1% vs 58.7%), unfavorable outcome (33.3% vs 33.8%), and death (9.8% vs 11.3%) at 3 months were similar between level 1 and 2 SUs. No significant association was found between time to IVT alone (onset-to-door, door-to-needle, and onset-to-needle) and functional outcomes. After adjustment, door-to-needle time ≤ 60 min (OR 4.005, 95% CI 1.232-13.016), shorter door-to-groin time (OR 0.991, 95% CI 0.983-0.999), shorter needle-to-groin time (OR 0.986, 95% CI 0.975-0.997), and shorter onset-to-groin time (OR 0.994, 95% CI 0.988-1.000) were associated with mRS 0-1. Shorter door-to-groin time (OR 0.991, 95% CI 0.984-0.998), door-to-groin time ≤ 90 min (OR 12.146, 95% CI 2.193-67.280), shorter needle-to-groin time (OR 0.983, 95% CI 0.972-0.995), and shorter onset-to-groin time (OR 0.993, 95% CI 0.987-0.999) were associated with mRS 0-2. Longer door-to-groin time (OR 1.007, 95% CI 1.001-1.014) and longer needle-to-groin time (OR 1.019, 95% CI 1.005-1.034) were associated with mRS 3-5, while door-to-groin time ≤ 90 min (OR 0.229, 95% CI 0.065-0.808) was inversely associated with mRS 3-5. Longer onset-to-needle time (OR 1.025, 95% CI 1.002-1.048) was associated with death. Times to treatment influenced the 3-month outcomes in patients treated with thrombectomy (bridging or primary). A revision of the current territorial organization for acute stroke treatments in Triveneto is needed to reduce transfer time and to increase the proportion of patients transferred from a level 1 SU to a level 2 SU to perform thrombectomy.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. .,USD Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | - Bruno Bonetti
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Forlivesi
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giulia Sajeva
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marcello Naccarato
- Stroke Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Paola Caruso
- Stroke Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Simone Lorenzut
- Stroke Unit, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Giovanni Merlino
- Stroke Unit, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Federica Viaro
- Stroke Unit, Azienda Ospedaliera Università di Padova, Padova, Italy
| | - Alessio Pieroni
- Stroke Unit, Azienda Ospedaliera Università di Padova, Padova, Italy
| | | | | | | | | | | | | | | | | | | | - Roberto L'Erario
- Stroke Unit, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Monia Russo
- Stroke Unit, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | | | - Paolo Passadore
- Stroke Unit, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Luca Zanet
- Stroke Unit, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Alberto Polo
- Stroke Unit, Ospedale Mater Salutis, Legnago, Italy
| | | | | | | | - Bruno Marini
- Stroke Unit, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy
| | - Martina Bruno
- Stroke Unit, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy
| | | | | | - Antonio Baldi
- Stroke Unit, Ospedale Di Portogruaro, Portogruaro, Italy
| | - Elisa Corazza
- Stroke Unit, Ospedale Di Portogruaro, Portogruaro, Italy
| | | | - Domenico Idone
- Stroke Unit, Ospedale Pederzoli, Peschiera del Garda, Italy
| | - Anna Gaudenzi
- Stroke Unit, Ospedale Santa Maria dei Battuti, Conegliano, Italy
| | - Roberto Bombardi
- Stroke Unit, Ospedale Santa Maria dei Battuti, Conegliano, Italy
| | - Morena Cadaldini
- Stroke Unit, Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, Italy
| | - Salvatore Lanzafame
- Stroke Unit, Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, Italy
| | | | | | | | | | | | | | - Roberta Padoan
- Stroke Unit, Ospedale Santa Maria del Prato, Feltre, Italy
| | - Giulio Bozzato
- Stroke Unit, Ospedale Santa Maria del Prato, Feltre, Italy
| | | | - Agnese Tonon
- Stroke Unit, Ospedale Santi Giovanni e Paolo, Venezia, Italy
| | - Paolo Bovi
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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3
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Tsivgoulis G, Kargiotis O, Rudolf J, Komnos A, Tavernarakis A, Karapanayiotides T, Ellul J, Katsanos AH, Giannopoulos S, Gryllia M, Safouris A, Papamichalis P, Vadikolias K, Mitsias P, Hadjigeorgiou G. Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience. Ther Adv Neurol Disord 2018; 11:1756286418783578. [PMID: 30034535 PMCID: PMC6048606 DOI: 10.1177/1756286418783578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion
treatment for acute ischemic stroke (AIS), however there are scarce data
regarding outcomes and complications of IVT in Greece. We evaluated safety
and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation
of Thrombolysis in Stroke: International Stroke Thrombolysis Register
(SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July
2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk
factors, baseline stroke severity [defined using National Institutes of
Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were
recorded. Safety outcomes included symptomatic intracranial hemorrhage
(sICH) and 3-month mortality rates. The efficacy outcomes evaluated a
reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month
favorable functional outcome [FFO; modified Rankin scale (mRS) scores of
0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety
and efficacy outcomes were assessed comparatively with previously published
data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers
participating in the SITS-ISTR during the study period (mean age 62.4 ±
12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150
min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the
SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction
in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5
(IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were
66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with
available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece.
Additional action is necessary in order to increase the availability of IVT
in the Greek population and to include more centers in the SITS-ISTR.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Jobst Rudolf
- Department of Neurology, Papageorgiou Hospital, Thessaloniki, Greece
| | | | | | - Theodoros Karapanayiotides
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - John Ellul
- Department of Neurology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Gryllia
- Department of Neurology, Athens General Hospital G. Gennimatas, Athens, Greece
| | - Apostolos Safouris
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | | | - Konstantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece
| | - Panayiotis Mitsias
- Department of Neurology Medical School, University of Crete, Heraklion, Crete, Greece
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