Personification of the approaches to reperfusion therapy of ischemic stroke

Cover Page


Cite item

Full Text

Abstract

Introduction. Systemic thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) is the “gold standard” of reperfusion therapy in certainpatients with ischemic stroke during the first 4.5 h after stroke onset.

Objective. To assess the clinical (severity of neurological symptoms) and laboratory (complete blood cell count test) factors that affect the disease prognosis aftersystemic thrombolytic therapy.

Materials and methods. Seventy patients (48 males and 22 females) aged 61 [54; 69] years with ischemic stroke who received systemic thrombolytic therapy withrtPA at a dose of 0.9 mg/kg were prospectively studied. Blood for the complete blood count test including neutrophil and lymphocyte counts was sampled before thethrombolytic therapy. The severity of neurological impairment was assessed using the NIH Stroke Scale. The functional prognosis was assessed 3 months afterstroke using the modified Rankin scale (mRS). Markers for the unfavorable prognosis of the acute phase of ischemic stroke (mRS score ≥3) were revealed by ROCanalysis involving sensitivity and specificity determination.

Results. Severity of neurological symptoms assessed using the NIH scale at admission was 15 [11; 17] points. Time between the manifestation of neurologicalsymptoms and admission to the hospital was 138 [117; 170] min; between admission and initiation of systemic thrombolytic therapy (the door-to-needle time),40 [30; 55] min. An unfavourable functional outcome of systemic thrombolytic therapy can be predicted according to the results of ROC analysis: the NIH score upon admissionbeing 12 or higher (sensitivity, 94%; specificity, 57%); neutrophil count, > 7.8•109/L (sensitivity, 45.5%; specificity, 90.6%); lymphocyte count, < 1.8•109/L(sensitivity, 81.8%; specificity, 59.4%).

Conclusions. The customized approach to systemic thrombolytic therapy can help predict its effectiveness and contribute to elaboration of adequate approachesto patient management. Patients with a potentially unfavourable prognosis for systemic thrombolysis can be the target group for using mechanical reperfusiontechniques such as thrombus extraction.

About the authors

Maksim A. Domashenko

Botkin Сity Clinic Hospital

Author for correspondence.
Email: mdomashenko@gmail.com
Россия, Moscow

Marina Yu. Maksimova

Research Center of Neurology

Email: mdomashenko@gmail.com
ORCID iD: 0000-0002-7682-6672
Россия, Moscow, Volokolamskoe shosse,80

Marina E. Gafarova

L.A. Vorokhobov City Clinical Hospital no. 67

Email: mdomashenko@gmail.com
Россия, Moscow

Marine M. Tanashyan

Research Center of Neurology

Email: mdomashenko@gmail.com
ORCID iD: 0000-0002-5883-8119

D. Sci. (Med.), Prof., Corresponding member of RAS, Deputy Director for science, Head, 1st Neurological department

Россия, Moscow

Kseniya V. Antonova

Research Center of Neurology

Email: mdomashenko@gmail.com
ORCID iD: 0000-0003-2373-2231

D. Sci. (Med.), leading researcher, 1st Neurological department

Россия, 125367 Moscow, Volokolamskoye shosse, 80

Mikhail A. Piradov

Research Center of Neurology

Email: mdomashenko@gmail.com
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Professor, Full Member of the Russian Academy of Sciences, Director

Россия, Moscow

References

  1. Powers W.J., Derdeyn C.P., Biller J. et al. 2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015; 46(10):3020-35. PMID: 26123479 doi: 10.1161/STR.0000000000000074.
  2. Skvortsova V.I., Golukhov G.N., Gubskiy L.V. et al. [Systemic thrombolysis in ischemic stroke]. Zhurn. nevrologii i psikhiatrii im. S.S. Korsakova. 2006; 106 (12): 24–31. (In Russ.)
  3. Domashenko M.A., Maksimova M.Yu., Loskutnikov M.A. et al. [System thrombolysis in acute ischemic stroke]. Annals of Clinical and Experimental Neurology, 2008; 2: 5–12. (In Russ.)
  4. Domashenko M.A., Maksimova M.Yu., Loskutnikov M.A. et al. [Mechanismsof reperfusion with intravenous thrombolytic therapy in patients withischemic stroke] Nevrologiya, neyropsikhiatriya, psiosomatika. 2012; 4: 53–58. (In Russ.)
  5. Piradov M.A., Domashenko M.A., Maksimova M.Yu. [Reperfusion treatmentof ischemic stroke]. In: [XXI Century Neurology: diagnostic, treatment andresearch technologies. In 3 Volumes. Eds. Piradov M.A., Illarioshkin S.N., Tanashyan.M.M.]. Moscow. ATMO, 2015. 2: P. 9–45. (In Russ.)
  6. Skvortsova V.I., Stakhovskaya L.V., Lelyuk V.G. et al. [Formation of the caresystem for stroke patients in Russian Federation] In: [Proc. of the Russ. Scient.-Pract. Conf. "Improving medical care for patients with vascular disease”]Yaroslavl', 2011: 13–33. (In Russ.)
  7. Shamalov N.A. [Problems and prospects of reperfusion therapy in ischemicstroke in Russia] Farmateka. 2015; 9: 14–19. (In Russ.)
  8. Emberson J., Lees K.R., Lyden P. et al. Effect of treatment delay, age, andstroke severity on the effects of intravenous thrombolysis with alteplase for acuteischaemic stroke: a meta-analysis of individual patient data from randomisedtrials. Lancet. 2014; 384(9958): 1929–35. PMID: 25106063 DOI: http://dx.doi.org/10.1016/S0140-6736(14)60584-5.
  9. Lees K., Bluhmki E., von Kummer R. et al. Time to treatment with intravenousalteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS,NINDS, and EPITHET trials. Lancet 2010; 375: 1695–703. PMID: 20472172 DOI: http://dx.doi.org/10.1016/S0140-6736(10)60491-6.
  10. Sandercock P., Wardlaw J.M., Lindley R.I. et al. The benefits and harmsof intravenous thrombolysis with recombinant tissue plasminogen activatorwithin 6 h of acute ischaemic stroke (the Third International Stroke Trial[IST-3]): a randomised controlled trial [published correction appears in Lancet2012;380:730]. Lancet. 2012; 379: 2352–63. PMID: 22632908 doi: 10.1016/S0140-6736(12)60768-5.
  11. Hacke W., Kaste M., Bluhmki E. et al. Thrombolysis with alteplase 3 to 4.5hours after acute ischemic stroke. N Engl J Med. 2008; 359: 1317–29. PMID: 18815396 DOI: http://dx.doi.org/10.1056/NEJMoa0804656.
  12. Shamalov N. A. Optimizatsiya reperfuzionnoy terapii u patsientov s ishemicheskiminsul'tom. Avtoref dis... dokt. med. nauk. [Optimization of reperfusiontherapy in patients with ischemic stroke. Author's abstract D.Sci (Med.) diss.].Мoscow; 2012: 47 p. (In Russ.)
  13. Lansberg M.G., Thijs V.N., Bammer R. et al. Risk factors of symptomaticintracerebral hemorrhage after tPA therapy for acute stroke. Stroke, 2007;38: 2275–8. PMID: 17569874 DOI: https://doi.org/10.1161/STROKEAHA.106.480475.
  14. Urbach H., Hartmann A., Pohl C. et al. Local intra-arterial thrombolysisin the carotid territory: does recanalization depend on the thromboembolustype? Neuroradiology, 2002; 44: 695–9. PMID: 12185548 DOI: http://dx.doi.org/10.1007/s00234-002-0762-6.
  15. Bhatia R., Hill M.D., Shobha N. et al. Low rates of acute recanalizationwith intravenous recombinant tissue plasminogen activator in ischemic stroke:real-world experience and a call for action. Stroke. 2010; 41(10): 2254–8. PMID: 20829513 DOI: http://dx.doi.org/10.1161/STROKEAHA.110.592535.
  16. Broderick J.P., Palesch Y.Y., Demchuk A.M. et al. Endovascular therapy afterintravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013; 368(10):893–903. PMID: 23390923 DOI: http://dx.doi.org/10.1056/NEJMoa1214300.
  17. Riedel C.H., Zimmermann P., Jensen-Kondering U. et al. The importanceof size: successful recanalization by intravenous thrombolysis in acute anteriorstroke depends on thrombus length. Stroke. 2011; 42(6): 1775–7. PMID: 21474810 DOI: http://dx.doi.org/10.1161/STROKEAHA.110.609693.
  18. Del Zoppo C.J., Poeck K., Pessin M.S. et al. Recombinant tissue plasminogenactivator in acute thrombotic and embolic stroke. Ann. Neurol., 1992, 32:78–86. PMID: 1642475 DOI: http://dx.doi.org/10.1002/ana.410320113.
  19. Mori E., Yoneda Y., Tabuchi M. et al. Intravenous recombinant tissue plasminogenactivator in acute carotid territory stroke. Neurology, 1992; 42: 976–82.PMID: 1579252.
  20. Adams H., Del Zoppo G., Alberts M. et al. Guidelines for the managementof adults with ischemic stroke. Stroke 2007; 38: 1655–711. PMID: 17431204doi: 10.1161/STROKEAHA.107.181486.
  21. Cucchiara B., Tanne D., Levine S.R. et al. A risk score to predict intracranialhemorrhage after recombinant tissue plasminogen activator for acute ischemicstroke. J Stroke Cerebrovasc Dis. 2008; 17: 331–3. PMID: 18984422 DOI:http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2008.03.012.
  22. Saqqur M., Shuaib A., Alexandrov A.V. et al. The correlation between admissionblood glucose and intravenous rt-PA-induced arterial recanalizationin acute ischemic stroke: a multi-centre TCD study. Int J Stroke. 2015; 10(7):1087–92. PMID: 26332252 doi: 10.1111/ijs.12517.
  23. Vanacker P., Heldner M.R., Seiffge D. et al. ASTRAL-R score predictsnon-recanalisation after intravenous thrombolysis in acute ischaemic stroke.Thrombosis and Haemostasis. 2015: 113(5): 911–7. PMID: 25854290 DOI:http://dx.doi.org/10.1160/TH14-06-0482.
  24. Demchuk A.M., Morgenstern L.B., Krieger D.W. et al. Serum glucose level,and diabetes predict tissue plasminogen activator–related intracerebral hemorrhagein acute ischemic stroke. Stroke. 1999; 30(1): 34–39. PMID: 9880385DOI: http://dx.doi.org/10.1161/01.STR.30.1.34.
  25. Whiteley W.N., Slot K.B., Fernandes P. et al. Risk factors for intracranialhemorrhage in acute ischemic stroke patients treated with recombinant tissueplasminogen activator: a systematic review and meta-analysis of 55 studiesStroke. 2012; 43(11): 2904–9. PMID: 22996959 DOI: http://dx.doi.org/10.1161/STROKEAHA.112.665331.
  26. Rocco A., Heuschmann P.U., Schellinger P.D. et al. Glycosylated hemoglobinA1 predicts risk for symptomatic hemorrhage after thrombolysis foracute stroke. Stroke. 2013; 44(8): 2134–8. PMID: 23715962 DOI: https://doi.org/10.1161/STROKEAHA.111.675918.
  27. Masrur S., Cox M., Bhatt D.L. et al. Association of acute and chronic hyperglycemiawith acute ischemic stroke outcomes post thrombolysis: findingsfrom get with the guidelines stroke. Journal of the American Heart Association:Cardiovascular and Cerebrovascular Disease. 2015; 4(10): e002193. PMID: 26408015 DOI: https://doi.org/10.1161/JAHA.115.002193.
  28. Tanashyan M.M., Suslina Z.A., Ionova V.G. et al. [Endothelial function inpatients with ischemic stroke at different degrees carotid artery atherosclerosis].Nevrologicheskii vestnik. Zhurnal im. V.M. Bekhtereva 2007; 29 (1): 12–16.(In Russ.)

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2017 Domashenko M.A., Maksimova M.Y., Gafarova M.E., Tanashyan M.M., Antonova K.V., Piradov M.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-83204 от 12.05.2022.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies