Key result
In stroke patients receiving thrombolytic therapy, cardiac sources of embolism were associated with a lower rate of complete recanalization compared to non-cardiac sources (19% vs. 39%, P=0.011).
Why the study?
Does the presence of a cardiac source of embolism affect the completeness of recanalization and clinical outcomes following thrombolytic therapy in stroke patients?
Observational (n=127)
Does the presence of a cardiac source of embolism affect the completeness of recanalization and clinical outcomes following thrombolytic therapy in stroke patients?
Absolute Event Rate: 19% vs 39%
p-value: p=0.011
In stroke patients receiving thrombolysis, a cardioembolic source is associated with a lower rate of complete recanalization and a higher risk of poor clinical outcomes at 3 months.
May prompt closer recanalization monitoring in cardioembolic stroke; leaves open whether etiology-specific reperfusion strategies warrant trials.
BACKGROUND: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. METHODS: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3 months. RESULTS: Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). CONCLUSIONS: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.
No takes yet. Share an insight, caveat, or question.
Nam et al. (2011) conducted an observational in Stroke with relevant artery occlusions (n=127). Cardiac sources of embolism (CSE) vs. Without cardiac sources of embolism was evaluated on Complete recanalization (TIMI 3) (p=0.011). In stroke patients receiving thrombolytic therapy, cardiac sources of embolism were associated with a lower rate of complete recanalization compared to non-cardiac sources (19% vs. 39%, P=0.011).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: