Stroke outcomes of Japanese patients with major cerebral artery occlusion in the post-alteplase, pre-MERCI era.

Abstract

This study examined outcomes of patients with acute ischemic stroke (AIS) with major cerebral artery occlusion after the approval of intravenous recombinant tissue-type plasminogen activator (IV rt-PA) but before approval of the MERCI retriever. We retrospectively enrolled 1170 consecutive patients with AIS and major cerebral artery occlusion (496 women; mean age, 73.9 ± 12.3 years) who were admitted within 24 hours after the onset of symptoms to 12 Japanese stroke centers between October 2005 and June 2009. Cardioembolism was a leading cause of AIS in this group (68.2%). The occlusion sites of the major cerebral arteries included the common carotid artery and internal carotid artery (ICA; 29.6%), middle cerebral artery (52.2%), and basilar artery (7.6%). Recanalization therapy (RT) was performed in 32.0% of patients (IV rt-PA, 20.0%; neuroendovascular therapy, 9.4%; combined, 2.5%). Symptomatic intracerebral hemorrhage within 36 hours with a ≥ 1-point increase in the National Institutes of Health Stroke Scale score occurred in 5.3% of the patients. At 3 months (or at hospital discharge), 29.3% of the patients had a favorable outcome (based on a modified Rankin scale score of 0-2), 23.8% were bedridden, and 15.6% died. After multivariate adjustment, RT was positively associated with a favorable outcome and negatively associated with death, whereas age, baseline National Institutes of Health Stroke Scale score, and ICA occlusion were negatively associated with a favorable outcome and positively associated with death. One-third of the patients with AIS and major cerebral artery occlusion were treated with RT, which was independently associated with favorable outcomes and death. However, 40% of the patients became bedridden or died during the post-alteplase, pre-MERCI era in Japan.

• Authors: Kaoru Endo, Masatoshi Koga, Nobuyuki Sakai, Hiroshi Yamagami, Eisuke Furui, Yasushi Matsumoto, Yoshiaki Shiokawa, Shinichi Yoshimura, Yasushi Okada, Jyoji Nakagawara, Toshio Hyogo, Yasuhiro Hasegawa, Hisashi Nagashima, Toshiyuki Fujinaka, Akio Hyodo, Tomoaki Terada, Kazunori Toyoda, Joint Research Group from JR-NET2 and SAMURAI Study Investigators
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 22 Issue 6 Pg. 805-10 (Aug 2013) ISSN: 1532-8511 [Electronic] United States
• PMID: 22721823 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Recombinant Proteins
• Tissue Plasminogen Activator

Topics

• Aged
• Aged, 80 and over
• Cerebral Hemorrhage (etiology)
• Cerebral Infarction (diagnosis, drug therapy, mortality)
• Chi-Square Distribution
• Disability Evaluation
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Japan
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Patient Discharge
• Recombinant Proteins (administration & dosage)
• Registries
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Thrombolytic Therapy (adverse effects, mortality)
• Time Factors
• Tissue Plasminogen Activator (administration & dosage, adverse effects)
• Treatment Outcome