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Neurological Sciences

, Volume 40, Issue 2, pp 319–326 | Cite as

Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome

  • Monica Bandettini di PoggioEmail author
  • Cinzia Finocchi
  • Federica Brizzo
  • Fiorella Altomonte
  • Francesca Bovis
  • Nicola Mavilio
  • Carlo Serrati
  • Laura Malfatto
  • GianLuigi Mancardi
  • Maurizio Balestrino
Original Article
  • 116 Downloads

Abstract

Background and aims

Monitoring the quality of acute ischemic stroke (AIS) management is increasingly important since patient outcome could be improved with better access to evidence-based treatments. In this scenario, the aim of our study was to identify thrombolysis rate, reasons for undertreatment, and factors associated with better outcome.

Methods

From January to December 2016, individuals diagnosed with AIS at the Policlinic San Martino Hospital in Genoa, Italy, were prospectively included. Severity of stroke, site of occlusion, rate and time related in-hospital management of systemic thrombolysis, and mechanical thrombectomy were recorded. Safety and clinical outcomes were compared between different subgroups.

Results

Of 459 AIS patients (57.3% females, mean age 78.1), 111 received i.v. thrombolysis (24.4%) and 50 received mechanical thrombectomy (10.9%). Apart from arrival behind the therapeutic window, which was the first limitation to thrombolysis, the main reason of undertreatment was minor stroke or stroke in rapid improvement. Baseline NIHSS ≥ 8 was associated with unfavorable clinical outcome (mRS > 2) (OR 20.1; 95% CI, 1.1–387.4, p = 0.047). Age older than 80 years (OR 5.0; 95% CI, 1.4–64.1, p = 0.01), baseline NIHSS ≥ 7 (OR 20.1; 95% CI, 1.1–387.4, p = 0.047), and symptomatic intracranial hemorrhage (OR 22.9; 95% CI, 2.0–254.2, p = 0.01) proved independently associated with mortality.

Conclusions

i.v. thrombolysis and mechanical thrombectomy rate was higher than that of previous reports. Minor stroke or stroke in rapid improvement was a major reason for exclusion from thrombolysis of eligible patients. Higher NIHSS proved an independent predictor of unfavorable clinical outcome and death. Strategies to avoid in-hospital delays need to be enforced.

Keywords

Stroke Management Clinical outcome Thrombolysis 

Notes

Acknowledgments

We thank Kristi Beshiri, Emanuele Giacheri, Simona Priora, and Angela Zuppa for their assistance in data collection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent was not required.

Supplementary material

10072_2018_3644_MOESM1_ESM.docx (21 kb)
Table S1 (DOCX 21 kb)
10072_2018_3644_MOESM2_ESM.docx (23 kb)
Table S2 (DOCX 22 kb)
10072_2018_3644_MOESM3_ESM.docx (21 kb)
Table S3 (DOCX 20 kb)

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Monica Bandettini di Poggio
    • 1
    Email author
  • Cinzia Finocchi
    • 1
  • Federica Brizzo
    • 1
  • Fiorella Altomonte
    • 2
  • Francesca Bovis
    • 3
  • Nicola Mavilio
    • 4
  • Carlo Serrati
    • 5
  • Laura Malfatto
    • 5
  • GianLuigi Mancardi
    • 1
  • Maurizio Balestrino
    • 1
  1. 1.Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenovaGenoaItaly
  2. 2.Emergency DepartmentPoliclinic San Martino HospitalGenoaItaly
  3. 3.Biostatistics Unit, Department of Health Sciences (DISSAL)University of GenovaGenoaItaly
  4. 4.Unit of NeuroradiologyPoliclinic San Martino HospitalGenoaItaly
  5. 5.Department of NeurosciencePoliclinic San Martino HospitalGenoaItaly

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