Abstract Details

Title Thrombolysis in Ischemic Stroke with No Arterial Occlusion: A Multiple Center, Multinational Retrospective Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S52 - (-)

Poster/Presentation
Number 003

Objective

Background Randomized trials report better outcome after thrombolysis in ischemic stroke but none adequately studied the subtypes of ischemic strokes. The subgroups of patients with no arterial occlusion at presentation continue to receive thrombolytic therapy without proven benefit and with some risk.

Design/Methods A retrospective medical record based observational multi center, multinational study was done at 5 centers from USA, Europe and India. Medical records of patients who presented during the last 5 years with ischemic stroke and no imaging (CTA/MRA) evidence of vascular occlusion were analyzed. Patients were divided into two groups, one that received thrombolytic therapy and the other that did not. Based on size and location of the infarct on MR diffusion weighted images, patients were divided into two subgroups, one with stroke caused by large vessel/embolic occlusion followed by spontaneous recanalization and the second as lacunar stroke due to intrinsic penetrating artery disease.

Results Complete data of 65 patients who were thrombolysed and had no arterial occlusion was compared with 135 controls. There was no significant difference in NIHSS at presentation (p = 0.562) and mRS at 90 days (p = 0.334) in patients who were thrombolysed and who were not. Symptomatic intracerebral bleed occurred in 3.92% of patients (n=51) who were thrombolysed versus 0% in controls(n=102). All cause mortality was 6.25% in the thrombolysis group versus 4.44% in non thrombolysed group.

Conclusions This retrospective analysis suggests that thrombolysis does not change the functional outcome of patients with ischemic stroke who do not have arterial occlusion at presentation. A larger study to comprehensively study on this subject is needed.

Authors/Disclosures
Sourabh Lahoti, MD (Coliseum Medical Centers) PRESENTER	No disclosure on file
Kailash P. Bhatia, MD, FAAN (UCL)	Dr. Bhatia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Dr. Bhatia has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MDS . Dr. Bhatia has received publishing royalties from a publication relating to health care.
Sankalp S. Gokhale, MD	Dr. Gokhale has received personal compensation for serving as an employee of Dianthus. Dr. Gokhale has stock in Dianthus.
Louis R. Caplan, MD, FAAN	No disclosure on file
Patrik L. Michel, MD	The institution of Dr. Michel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Michel has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. The institution of Dr. Michel has received research support from Swiss National Science Foundation; Swiss Heart Foundation.
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA)	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Yves Samson, MD	No disclosure on file
Charlotte Rosso	No disclosure on file
Nikita Dedhia, MD	No disclosure on file
Shirish M. Hastak, MD	No disclosure on file

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