Search

Background & Purpose: There are scarce data regarding outcomes of AIS patients treated with IVT within 60 min from symptom onset (“golden hour”). We sought to compare outcomes between AIS patients treated within (OTT≤60 min) and outside (OTT: 61-270min) the “golden hour” [GH(+) & GH (-)] using a propensity score matching approach. Methods: Patients were evaluated during a 12-year period in a large, international, prospective registry of IVT (SITS-EAST). They underwent serial NIHSS-score assessments at baseline, 2 hrs and 24 hrs following tPA-bolus. Clinical recovery (CR) at 2 and 24 hrs was defined as a reduction of ≥10 points in NIHSS-score compared with baseline, or a NIHSS-score of ≤3 at 2 and 24 hrs respectively. A relative reduction in NIHSS-score of ≥40% at 2 hrs was predictive of complete recanalization (CREC). sICH was defined using SITS-MOST criteria; 3-month favourable functional outcome (FFO) was defined as a mRS-score of 0-1. The two groups were matched for demographics, risk factors, baseline NIHSS, admission blood pressure and serum glucose. Results: Out of 19.077 tPA-treated AIS patients, 71 patients in GH(+) group [mean age 67±13 years; median NIHSS-score 12 points (IQR 10); median onset to treatment time (OTT) 55min, (IQR 10)] were matched to 6882 patients in GH(-) group (mean age 67±12 years; median NIHSS-score 11 points (IQR 9); median OTT 155min (IQR 55)]. The two groups did not differ in any of the matched characteristics (p>0.1). GH(+) had significantly (p0.2) in the two groups. GH(+) was independently (p Conclusions: AIS patients treated with IVT within the GH have substantially higher odds of early CR and FFO. These findings highlight the potential of mobile stroke units to further improve AIS outcomes by increasing the rates of tPA delivery within the GH.

Introduction: There is no conclusive evidence if the association between status of brain artery and risk of intracerebral hemorhage after intravenous thrombolysis (IVT) exists. Therefore, we explored if the hyperdense cerebral artery sign (HCAS) on CT or CT-angiography (CTA)-evidenced occlusion at baseline and follow-up after intravenous thrombolysis (IVT) is associated with symptomatic intracerebral hemorrhage (SICH). Methods: The study population was the Safe Implementation of Treatments in Stroke-EAST (SITS-EAST) database with all stroke patients between February 2003 and December 2011 receiving IVT up to 4.5 hours after symptom onset. SICH was distinguished as per NINDS, ECASS II and SITS-MOST definitions. Arterial patency at baseline and on follow-up was assessed by the presence of HCAS on CT or by CTA. Logistic regression was used to adjust for differences in the following baseline variables: NIHSS baseline, age, sex, onset to treatment time, weight, early ischemic changes on CT, systolic blood pressure, glucose, actilyse dose, treatment with anticoagulation or antiplatelets, stroke subtype by ICD classification, history of hypertension, diabetes mellitus, atrial fibrillation, congestive heart failure, and previous stroke. Results: Of 8878 cases, baseline CT scans revealed HCAS in 1553 (19%) of 8375 patients and CTA-evidenced occlusion in 1606 (57%) of 2809 cases. On follow-up CT after IVT, HCAS persisted in 477 (36%) of 1327 cases and CTA-evidenced occlusion persisted in 185 (45%) of 411 cases. After adjustment, SICH per the NINDS definition was independently predicted at baseline both by the presence of HCAS (OR 1.57, 95%CI 1.20 to 2.05) and occlusion on CTA (OR 2.87, 95%CI 1.69 to 4.87). Also SICH per the ECASS II definition was independently predicted by the presence of occlusion on CTA (OR 2.61, 95%CI 1.34 to 5.05). In contrast, at follow-up neither persistent HCAS nor persistent CTA-evidenced occlusion was associated with SICH per any definition. Conclusions: In stroke patients receiving IVT, presence of clot at admission was an independent predictor of SICH. Persistent occlusion after IVT was not, however, associated with SICH.