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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
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Thrombolysis in right versus left hemispheric stroke.

Nicholas A Blondin1, Ilene Staff, Nora Lee

  • 1Department of Medical Education, University of Connecticut School of Medicine, Farmington, CT 06030, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|May 18, 2010
PubMed
Summary

Patients with right hemispheric stroke (RHS) and left hemispheric stroke (LHS) show no difference in emergency department presentation times or receiving intravenous (IV) tissue plasminogen activator (t-PA). This challenges previous findings on stroke treatment disparities.

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Area of Science:

  • Neurology
  • Stroke Medicine
  • Emergency Medicine

Background:

  • Previous studies suggested right hemispheric stroke (RHS) patients have delayed emergency department (ED) presentation and lower rates of intravenous (IV) tissue plasminogen activator (t-PA) administration compared to left hemispheric stroke (LHS) patients.
  • These disparities were associated with poorer clinical outcomes in RHS patients.

Purpose of the Study:

  • To investigate if a difference exists in the rate of IV t-PA administration based on the affected brain hemisphere in a large community population.
  • To compare emergency department presentation times between patients with RHS and LHS.

Main Methods:

  • Analysis of a large, prospective cohort of acute stroke patients treated with IV t-PA at a hospital stroke center from October 2000 to October 2006.
  • Comparison of IV t-PA administration rates and presentation times within 3 hours of stroke onset between RHS and LHS patient groups.

Main Results:

  • Of 2,932 ischemic stroke patients, 953 met study criteria, with 151 receiving IV t-PA.
  • No significant difference was found in presentation times within 3 hours between RHS and LHS groups (P=.180).
  • There was no statistically significant difference in IV t-PA use between patients with RHS and LHS (P=.237).

Conclusions:

  • The study found no difference in emergency department presentation times or IV t-PA administration rates between patients with right hemispheric stroke and left hemispheric stroke.
  • This contradicts previous research and may indicate improved recognition and management of right-sided stroke syndromes.
  • Findings suggest potential improvements in stroke care equity across different hemispheric involvements.