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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Transient ischemic attack after tissue plasminogen activator: aborted stroke or unnecessary stroke therapy?
Ken Uchino1, Lori Massaro, Maxim D Hammer
1UPMC Stroke Institute, Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA. uchinok@ccf.org
Cerebrovascular Diseases (Basel, Switzerland)
|November 7, 2009
Summary
Over 10% of patients treated with tissue plasminogen activator (tPA) for acute ischemic stroke do not have an ischemic injury. Non-ischemic diagnoses are infrequent but linked to community hospital administration.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- The frequency of normal clinical and radiographic outcomes after intravenous thrombolysis for acute ischemic stroke is not well-established.
- Assessing outcomes is crucial for optimizing stroke treatment protocols.
Purpose of the Study:
- To determine the incidence of non-ischemic processes, transient ischemic attacks (TIAs), and confirmed ischemic strokes in patients receiving tissue plasminogen activator (tPA).
- To identify predictors associated with these different outcomes following tPA administration.
Main Methods:
- Retrospective analysis of patients receiving intravenous thrombolysis with tPA at community hospitals and a stroke center.
- Classification of outcomes into non-ischemic process (stroke mimic), TIA, or ischemic stroke.
- Evaluation of occurrence rates and potential predictors for each condition.
Main Results:
- Out of 254 patients treated with tPA, 3.5% had a non-ischemic process, 9.1% had a TIA, and 87% were diagnosed with ischemic stroke.
- Patients with non-ischemic processes were younger and more likely to receive tPA at community hospitals.
- TIA was associated with lower pretreatment glucose, less coronary artery disease, and lower stroke severity, but not treatment time.
Conclusions:
- More than 10% of patients receiving tPA for suspected cerebral ischemia do not ultimately develop ischemic injury.
- While infrequent, tPA administration for non-ischemic processes is associated with treatment at community hospitals.
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