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

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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.

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Acknowledgments

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

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Authors and Affiliations

  1. Policlinic San Martino Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy

    Monica Bandettini di Poggio, Cinzia Finocchi, Federica Brizzo, GianLuigi Mancardi & Maurizio Balestrino

  2. Emergency Department, Policlinic San Martino Hospital, Genoa, Italy

    Fiorella Altomonte

  3. Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy

    Francesca Bovis

  4. Unit of Neuroradiology, Policlinic San Martino Hospital, Genoa, Italy

    Nicola Mavilio

  5. Department of Neuroscience, Policlinic San Martino Hospital, Genoa, Italy

    Carlo Serrati & Laura Malfatto

Authors
  1. Monica Bandettini di Poggio
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  2. Cinzia Finocchi
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  3. Federica Brizzo
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  4. Fiorella Altomonte
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  5. Francesca Bovis
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  6. Nicola Mavilio
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  7. Carlo Serrati
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  8. Laura Malfatto
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  9. GianLuigi Mancardi
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  10. Maurizio Balestrino
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Correspondence to Monica Bandettini di Poggio.

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Bandettini di Poggio, M., Finocchi, C., Brizzo, F. et al. Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome. Neurol Sci 40, 319–326 (2019). https://doi.org/10.1007/s10072-018-3644-3

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  • DOI: https://doi.org/10.1007/s10072-018-3644-3

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