Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke: A Cohort Study
The value of multimodal CT to assist thrombolysis has received little attention in stroke. We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic the...
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| Veröffentlicht in: | Stroke (1970) 2011-04, Vol.42 (4), p.1129-1131 |
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| container_title | Stroke (1970) |
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| creator | OBACH, Victor OLEAGA, Laura VARGAS, Martha TORRES, Ferrán CHAMORRO, Angel URRA, Xabier MACHO, Juan AMARO, Sergio CAPURRO, Sebastian GOMEZ-CHOCO, Manuel SAN ROMAN, Luís CERVERA, Alvaro BLASCO, Jordi |
| description | The value of multimodal CT to assist thrombolysis has received little attention in stroke.
We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005-2009).
Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50-5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68-11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80-2.16; interaction test P=0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups.
Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings. |
| doi_str_mv | 10.1161/STROKEAHA.110.605766 |
| format | Article |
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We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005-2009).
Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50-5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68-11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80-2.16; interaction test P=0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups.
Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.110.605766</identifier><identifier>PMID: 21330631</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cohort Studies ; Female ; Fibrinolysis - drug effects ; Fibrinolytic Agents - administration & dosage ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; Prospective Studies ; Stroke - diagnostic imaging ; Stroke - drug therapy ; Thrombolytic Therapy - adverse effects ; Thrombolytic Therapy - methods ; Tissue Plasminogen Activator - administration & dosage ; Tissue Plasminogen Activator - adverse effects ; Tomography, X-Ray Computed - adverse effects ; Tomography, X-Ray Computed - methods ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2011-04, Vol.42 (4), p.1129-1131</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c285t-eb4cd57172ad3f31bac55b886671d30b8c79b146210804cb10005f2801f98e723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24069294$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21330631$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>OBACH, Victor</creatorcontrib><creatorcontrib>OLEAGA, Laura</creatorcontrib><creatorcontrib>VARGAS, Martha</creatorcontrib><creatorcontrib>TORRES, Ferrán</creatorcontrib><creatorcontrib>CHAMORRO, Angel</creatorcontrib><creatorcontrib>URRA, Xabier</creatorcontrib><creatorcontrib>MACHO, Juan</creatorcontrib><creatorcontrib>AMARO, Sergio</creatorcontrib><creatorcontrib>CAPURRO, Sebastian</creatorcontrib><creatorcontrib>GOMEZ-CHOCO, Manuel</creatorcontrib><creatorcontrib>SAN ROMAN, Luís</creatorcontrib><creatorcontrib>CERVERA, Alvaro</creatorcontrib><creatorcontrib>BLASCO, Jordi</creatorcontrib><title>Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke: A Cohort Study</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>The value of multimodal CT to assist thrombolysis has received little attention in stroke.
We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005-2009).
Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50-5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68-11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80-2.16; interaction test P=0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups.
Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fibrinolysis - drug effects</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Prospective Studies</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - drug therapy</subject><subject>Thrombolytic Therapy - adverse effects</subject><subject>Thrombolytic Therapy - methods</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tissue Plasminogen Activator - adverse effects</subject><subject>Tomography, X-Ray Computed - adverse effects</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkElPwzAQhS0EgrL8A4R8QZwC3uNwiyI2UcQWxDFyHEcNJDHYzqH_HqOWchq90Tczbx4AxxidYyzwxWv58nh_ld_mUaJzgXgqxBaYYU5YwgSR22CGEM0SwrJsD-x7_4EQIlTyXbBHMKVIUDwDzw9TH7rBNqqHRZnk3nc-mAaWC2eH2vbLqGE3wicVOjMGD9-7sIC5noKBr8HZT3MJc1jYhXUhNqZmeQh2WtV7c7SuB-Dt-qosbpP5481dkc8TTSQPiamZbniKU6Ia2lJcK815LaUQKW4oqqVOsxrHRzCSiOkaR_e8JRLhNpMmJfQAnK32fjn7PRkfqqHz2vS9Go2dfCV5RjLCGY0kW5HaWe-daasv1w3KLSuMqt8sq02WUaJqlWUcO1kfmOrBNJuhv_AicLoGlNeqb50adef_OYZEtMDoD6Gze7M</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>OBACH, Victor</creator><creator>OLEAGA, Laura</creator><creator>VARGAS, Martha</creator><creator>TORRES, Ferrán</creator><creator>CHAMORRO, Angel</creator><creator>URRA, Xabier</creator><creator>MACHO, Juan</creator><creator>AMARO, Sergio</creator><creator>CAPURRO, Sebastian</creator><creator>GOMEZ-CHOCO, Manuel</creator><creator>SAN ROMAN, Luís</creator><creator>CERVERA, Alvaro</creator><creator>BLASCO, Jordi</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110401</creationdate><title>Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke: A Cohort Study</title><author>OBACH, Victor ; OLEAGA, Laura ; VARGAS, Martha ; TORRES, Ferrán ; CHAMORRO, Angel ; URRA, Xabier ; MACHO, Juan ; AMARO, Sergio ; CAPURRO, Sebastian ; GOMEZ-CHOCO, Manuel ; SAN ROMAN, Luís ; CERVERA, Alvaro ; BLASCO, Jordi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c285t-eb4cd57172ad3f31bac55b886671d30b8c79b146210804cb10005f2801f98e723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fibrinolysis - drug effects</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Prospective Studies</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - drug therapy</topic><topic>Thrombolytic Therapy - adverse effects</topic><topic>Thrombolytic Therapy - methods</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tissue Plasminogen Activator - adverse effects</topic><topic>Tomography, X-Ray Computed - adverse effects</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>OBACH, Victor</creatorcontrib><creatorcontrib>OLEAGA, Laura</creatorcontrib><creatorcontrib>VARGAS, Martha</creatorcontrib><creatorcontrib>TORRES, Ferrán</creatorcontrib><creatorcontrib>CHAMORRO, Angel</creatorcontrib><creatorcontrib>URRA, Xabier</creatorcontrib><creatorcontrib>MACHO, Juan</creatorcontrib><creatorcontrib>AMARO, Sergio</creatorcontrib><creatorcontrib>CAPURRO, Sebastian</creatorcontrib><creatorcontrib>GOMEZ-CHOCO, Manuel</creatorcontrib><creatorcontrib>SAN ROMAN, Luís</creatorcontrib><creatorcontrib>CERVERA, Alvaro</creatorcontrib><creatorcontrib>BLASCO, Jordi</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>OBACH, Victor</au><au>OLEAGA, Laura</au><au>VARGAS, Martha</au><au>TORRES, Ferrán</au><au>CHAMORRO, Angel</au><au>URRA, Xabier</au><au>MACHO, Juan</au><au>AMARO, Sergio</au><au>CAPURRO, Sebastian</au><au>GOMEZ-CHOCO, Manuel</au><au>SAN ROMAN, Luís</au><au>CERVERA, Alvaro</au><au>BLASCO, Jordi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke: A Cohort Study</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>42</volume><issue>4</issue><spage>1129</spage><epage>1131</epage><pages>1129-1131</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>The value of multimodal CT to assist thrombolysis has received little attention in stroke.
We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005-2009).
Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50-5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68-11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80-2.16; interaction test P=0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups.
Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21330631</pmid><doi>10.1161/STROKEAHA.110.605766</doi><tpages>3</tpages></addata></record> |
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| ispartof | Stroke (1970), 2011-04, Vol.42 (4), p.1129-1131 |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Biological and medical sciences Cohort Studies Female Fibrinolysis - drug effects Fibrinolytic Agents - administration & dosage Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology Prospective Studies Stroke - diagnostic imaging Stroke - drug therapy Thrombolytic Therapy - adverse effects Thrombolytic Therapy - methods Tissue Plasminogen Activator - administration & dosage Tissue Plasminogen Activator - adverse effects Tomography, X-Ray Computed - adverse effects Tomography, X-Ray Computed - methods Vascular diseases and vascular malformations of the nervous system |
| title | Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke: A Cohort Study |
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