Abstract 2669: Stroke Outcome After Intravenous Thrombolysis. The Stroke Etiology Does Not Matter.
Objectives: To identify possible diferences in stroke outcome related to stroke etiology in acute ischemic stroke (IS) patients who receive intravenous thrombolysis (IVT).
Methods: Multicenter Stroke Register with prospective inclusion of consecutive acute IS patients treated with IVT according to SITS-MOST criteria in five acute stroke units in the same city. We compared neurological improvement within the first 24 hours (baseline-24 hours NIHSS) and at day 7 (baseline-7 day NIHSS) as well as functional outcome at 3 months measured by the modified Rankin Scale (mRS) among the different etiological stroke subtypes.
Results: Of the total of 1429 patients included. 617 (43.2%) had cardioembolic IS, 334 (23.4%) had a IS of unknown origin, 174 (12.2%) had large vessel disease (LVD) with arterial stenosis, 171 (12%) LVD with no significant stenosis, 72 (5%) were IS of uncommon origin and 61 (4.3%) were lacunar infarction. Patients with lacunar infarction had the lower stroke severity (median NIHSS 6) whilst cardioembolic IS were the most severe (median NIHSS 15) (p<.001). No differences in NIHSS improvement at 24 hours from baseline were found among groups (LVD with arterial stenosis 3.4; LVD without arterial stenosis 4.7; cardioembolism 4.6; lacunar infarction 3.8; uncommon origin 3.6; unknown origin 3.9; p=0.141). At day seven patients with cardioembolism had the highest improvement in NIHSS from baseline (6.7) whilst those with lacunar infarction improved least (4.4) (p=0.02). Patients with LVD with arterial stenosis (OR 051; 95%IC 0.34-0.77) and those with IS of uncommon origin (OR 0.50; 95%IC 0.28-0.89) were the less prone to get a significant neurological improvement at day seven after adjustment for age, gender, vascular risk factors and stroke severity on admission. At 3 months up to 50.6% of patients with LVD and arterial stenosis, 34.5% with LVD without arterial stenosis, 46.2% cardioembolic IS, 15.1% lacunar infarction, 38.6% IS of uncommon origin and 37.7% of unknown etiology had mRS>2. Nevertheless, adjusted multivariate analysis showed no influence of stroke etiological subtype on stroke outcome (mRS) at 3 months.
Conclusion: The stroke etiological subtype does not determine differences in IS outcome at 3 months after IVT, although those patients with LVD with arterial stenosis or of uncommon origin improve less than the other etiologies at day 7.
- © 2012 by American Heart Association, Inc.