Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units-Reference-Cited by-同舟云学术

Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

Published:2023-10-20 Issue:2 Volume:95 Page:347-361
ISSN:0364-5134
Container-title:Annals of Neurology
language:en
Short-container-title:Annals of Neurology

Author:

Navi Babak B.¹^ORCID,Bach Ivo²,Czap Alexandra L.²,Wang Mengxi³,Yamal Jose‐Miguel³,Jacob Asha P.²,Parker Stephanie A.²,Rajan Suja S.³^ORCID,Mir Saad¹,Sherman Carla¹,Willey Joshua Z.⁴^ORCID,Saver Jeffrey L.⁵,Gonzalez Michael O.³,Singh Noopur³,Jones William J.⁶,Ornelas David⁶,Gonzales Nicole R.⁶,Alexandrov Anne W.⁷,Alexandrov Andrei V.⁸,Nour May⁵,Spokoyny Ilana⁹,Mackey Jason¹⁰,Collins Sarah Q.¹⁰,Silnes Kelly¹¹^ORCID,Fink Mathew E.¹,English Joey⁹,Barazangi Nobl⁹,Bratina Patti L.²,Volpi Jay¹²,Rao Chethan P. V.¹³,Griffin Laura¹⁴,Persse David¹⁵,Grotta James C.¹⁶

Affiliation:

1. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York NY

2. Department of Neurology UTHealth McGovern Medical School Houston TX

3. Department of Biostatistics and Data Science UTHealth School of Public Health Houston TX

4. Department of Neurology Columbia University Irving Medical Center New York NY

5. Department of Neurology Ronald Reagan UCLA Medical Center Los Angeles CA

6. Department of Neurology University of Colorado Aurora CO

7. Department of Neurology, College of Nursing and College of Medicine University of Tennessee Health Science Center Memphis TN

8. Department of Neurology University of Arizona, Banner University Medical Center Phoenix AZ

9. Department of Neurology Mills Peninsula Medical Center Burlingame CA

10. Department of Neurology Indiana University School of Medicine Indianapolis IN

11. University of Buckingham Medical School Buckingham UK

12. Department of Neurology Houston Methodist Hospital Houston TX

13. Department of Neurology Baylor College of Medicine Houston TX

14. HCA Houston Healthcare Houston TX

15. Department of Emergency Medicine Baylor College of Medicine Houston TX

16. Clinical Innovation and Research Institute, Memorial Hermann Hospital–Texas Medical Center Houston TX

Abstract

ObjectiveThis study was undertaken to examine averted stroke in optimized stroke systems.MethodsThis secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue‐defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis.ResultsAmong 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue‐defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue‐defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue‐defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue‐defined averted stroke and stroke with early symptom resolution.InterpretationIn optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361

Funder

Patient-Centered Outcomes Research Institute

Publisher

Wiley

Subject

Neurology (clinical),Neurology

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ana.26816

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