Correlation between the occlusion site and clinical outcome after acute ischemic stroke

Kentaro Suzuki, Junya Aoki, Takao Kanzawa, Yasuhiro Nishiyama, Yohei Takayama, Hiroaki Kimura, Satoshi Takahashi, Tadashige Kano, Kazunori Akaji, Yoshio Tanizaki, Kazumi Kimura, Ban Mihara

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective The significance of early mild clinical improvement after intravenous tissue plasminogen activator (IVtPA) treatment is unclear. Therefore, we examined whether the timing of clinical improvement after IVtPA predicted the clinical outcome at 3 months. Methods Consecutive patients with acute cerebral infarction in the anterior circulation who received IVtPA treatment within 3 hours of the onset of symptoms were enrolled in the study. Patients were classified according to the timing of clinical improvement [early responder (ER), National Institutes of Health Stroke Scale (NIHSS) score improved ≥4 points or who had a score of 0 within 2 hours after IVtPA; late responder (LR), a similar improvement between 2 and 24 hours; and non-responder (NR)] and according to the arterial occlusion site (P group, internal carotid artery and proximal middle cerebral artery M1 region; and D group, distal M1 and M2). Results Ninety-three patients [median age, 74 (67-79) years; 54 men (58%); median NIHSS score, 11 (7- 16)] were enrolled in the study. The P group consisted of 48 (52%) patients and the D group consisted of 45 (48%) patients. Thirty-eight patients (41%) were classified as ERs, 20 (22%) as LRs, and 35 (38%) as NRs. On a multivariate regression analysis, the P group [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.08- 10.45; p=0.036] and NR (OR, 4.04; 95% CI, 1.29-14.27; p=0.016) were independent predictors of a poor outcome. ER (47%, p=0.01) and LR (45%, p=0.01) patients showed fewer poor outcomes than NR (77%) patients, but the rate did not differ significantly between the ER and LR patients. Conclusion Early mild clinical recovery did not predict a good outcome. The occlusion site was a stronger predictor of clinical improvement after IVtPA administration.

Original languageEnglish
Pages (from-to)3139-3144
Number of pages6
JournalInternal Medicine
Volume54
Issue number24
DOIs
Publication statusPublished - 2015 Dec 15
Externally publishedYes

Fingerprint

Stroke
Tissue Plasminogen Activator
National Institutes of Health (U.S.)
Odds Ratio
Confidence Intervals
Brain Infarction
Middle Cerebral Artery
Internal Carotid Artery
Multivariate Analysis
Regression Analysis
Therapeutics

Keywords

  • Ischemic stroke
  • Occlusion site
  • Outcome
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Suzuki, K., Aoki, J., Kanzawa, T., Nishiyama, Y., Takayama, Y., Kimura, H., ... Mihara, B. (2015). Correlation between the occlusion site and clinical outcome after acute ischemic stroke. Internal Medicine, 54(24), 3139-3144. https://doi.org/10.2169/internalmedicine.54.4990

Correlation between the occlusion site and clinical outcome after acute ischemic stroke. / Suzuki, Kentaro; Aoki, Junya; Kanzawa, Takao; Nishiyama, Yasuhiro; Takayama, Yohei; Kimura, Hiroaki; Takahashi, Satoshi; Kano, Tadashige; Akaji, Kazunori; Tanizaki, Yoshio; Kimura, Kazumi; Mihara, Ban.

In: Internal Medicine, Vol. 54, No. 24, 15.12.2015, p. 3139-3144.

Research output: Contribution to journalArticle

Suzuki, K, Aoki, J, Kanzawa, T, Nishiyama, Y, Takayama, Y, Kimura, H, Takahashi, S, Kano, T, Akaji, K, Tanizaki, Y, Kimura, K & Mihara, B 2015, 'Correlation between the occlusion site and clinical outcome after acute ischemic stroke', Internal Medicine, vol. 54, no. 24, pp. 3139-3144. https://doi.org/10.2169/internalmedicine.54.4990
Suzuki K, Aoki J, Kanzawa T, Nishiyama Y, Takayama Y, Kimura H et al. Correlation between the occlusion site and clinical outcome after acute ischemic stroke. Internal Medicine. 2015 Dec 15;54(24):3139-3144. https://doi.org/10.2169/internalmedicine.54.4990
Suzuki, Kentaro ; Aoki, Junya ; Kanzawa, Takao ; Nishiyama, Yasuhiro ; Takayama, Yohei ; Kimura, Hiroaki ; Takahashi, Satoshi ; Kano, Tadashige ; Akaji, Kazunori ; Tanizaki, Yoshio ; Kimura, Kazumi ; Mihara, Ban. / Correlation between the occlusion site and clinical outcome after acute ischemic stroke. In: Internal Medicine. 2015 ; Vol. 54, No. 24. pp. 3139-3144.
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abstract = "Objective The significance of early mild clinical improvement after intravenous tissue plasminogen activator (IVtPA) treatment is unclear. Therefore, we examined whether the timing of clinical improvement after IVtPA predicted the clinical outcome at 3 months. Methods Consecutive patients with acute cerebral infarction in the anterior circulation who received IVtPA treatment within 3 hours of the onset of symptoms were enrolled in the study. Patients were classified according to the timing of clinical improvement [early responder (ER), National Institutes of Health Stroke Scale (NIHSS) score improved ≥4 points or who had a score of 0 within 2 hours after IVtPA; late responder (LR), a similar improvement between 2 and 24 hours; and non-responder (NR)] and according to the arterial occlusion site (P group, internal carotid artery and proximal middle cerebral artery M1 region; and D group, distal M1 and M2). Results Ninety-three patients [median age, 74 (67-79) years; 54 men (58{\%}); median NIHSS score, 11 (7- 16)] were enrolled in the study. The P group consisted of 48 (52{\%}) patients and the D group consisted of 45 (48{\%}) patients. Thirty-eight patients (41{\%}) were classified as ERs, 20 (22{\%}) as LRs, and 35 (38{\%}) as NRs. On a multivariate regression analysis, the P group [odds ratio (OR), 3.24; 95{\%} confidence interval (CI), 1.08- 10.45; p=0.036] and NR (OR, 4.04; 95{\%} CI, 1.29-14.27; p=0.016) were independent predictors of a poor outcome. ER (47{\%}, p=0.01) and LR (45{\%}, p=0.01) patients showed fewer poor outcomes than NR (77{\%}) patients, but the rate did not differ significantly between the ER and LR patients. Conclusion Early mild clinical recovery did not predict a good outcome. The occlusion site was a stronger predictor of clinical improvement after IVtPA administration.",
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AU - Suzuki, Kentaro

AU - Aoki, Junya

AU - Kanzawa, Takao

AU - Nishiyama, Yasuhiro

AU - Takayama, Yohei

AU - Kimura, Hiroaki

AU - Takahashi, Satoshi

AU - Kano, Tadashige

AU - Akaji, Kazunori

AU - Tanizaki, Yoshio

AU - Kimura, Kazumi

AU - Mihara, Ban

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N2 - Objective The significance of early mild clinical improvement after intravenous tissue plasminogen activator (IVtPA) treatment is unclear. Therefore, we examined whether the timing of clinical improvement after IVtPA predicted the clinical outcome at 3 months. Methods Consecutive patients with acute cerebral infarction in the anterior circulation who received IVtPA treatment within 3 hours of the onset of symptoms were enrolled in the study. Patients were classified according to the timing of clinical improvement [early responder (ER), National Institutes of Health Stroke Scale (NIHSS) score improved ≥4 points or who had a score of 0 within 2 hours after IVtPA; late responder (LR), a similar improvement between 2 and 24 hours; and non-responder (NR)] and according to the arterial occlusion site (P group, internal carotid artery and proximal middle cerebral artery M1 region; and D group, distal M1 and M2). Results Ninety-three patients [median age, 74 (67-79) years; 54 men (58%); median NIHSS score, 11 (7- 16)] were enrolled in the study. The P group consisted of 48 (52%) patients and the D group consisted of 45 (48%) patients. Thirty-eight patients (41%) were classified as ERs, 20 (22%) as LRs, and 35 (38%) as NRs. On a multivariate regression analysis, the P group [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.08- 10.45; p=0.036] and NR (OR, 4.04; 95% CI, 1.29-14.27; p=0.016) were independent predictors of a poor outcome. ER (47%, p=0.01) and LR (45%, p=0.01) patients showed fewer poor outcomes than NR (77%) patients, but the rate did not differ significantly between the ER and LR patients. Conclusion Early mild clinical recovery did not predict a good outcome. The occlusion site was a stronger predictor of clinical improvement after IVtPA administration.

AB - Objective The significance of early mild clinical improvement after intravenous tissue plasminogen activator (IVtPA) treatment is unclear. Therefore, we examined whether the timing of clinical improvement after IVtPA predicted the clinical outcome at 3 months. Methods Consecutive patients with acute cerebral infarction in the anterior circulation who received IVtPA treatment within 3 hours of the onset of symptoms were enrolled in the study. Patients were classified according to the timing of clinical improvement [early responder (ER), National Institutes of Health Stroke Scale (NIHSS) score improved ≥4 points or who had a score of 0 within 2 hours after IVtPA; late responder (LR), a similar improvement between 2 and 24 hours; and non-responder (NR)] and according to the arterial occlusion site (P group, internal carotid artery and proximal middle cerebral artery M1 region; and D group, distal M1 and M2). Results Ninety-three patients [median age, 74 (67-79) years; 54 men (58%); median NIHSS score, 11 (7- 16)] were enrolled in the study. The P group consisted of 48 (52%) patients and the D group consisted of 45 (48%) patients. Thirty-eight patients (41%) were classified as ERs, 20 (22%) as LRs, and 35 (38%) as NRs. On a multivariate regression analysis, the P group [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.08- 10.45; p=0.036] and NR (OR, 4.04; 95% CI, 1.29-14.27; p=0.016) were independent predictors of a poor outcome. ER (47%, p=0.01) and LR (45%, p=0.01) patients showed fewer poor outcomes than NR (77%) patients, but the rate did not differ significantly between the ER and LR patients. Conclusion Early mild clinical recovery did not predict a good outcome. The occlusion site was a stronger predictor of clinical improvement after IVtPA administration.

KW - Ischemic stroke

KW - Occlusion site

KW - Outcome

KW - Tissue plasminogen activator

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