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Published on: November 26, 2013
Thrombolysis in Stroke-Heart Syndrome: a useful tool for neurocardiac wellness?
Ilario Scali1, Marcello Naccarato2, Gabriele Prandin2
1Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Clinical University Hospital of Trieste (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy. scalilario@gmail.com.
Insights
Thrombolysis before thrombectomy may reduce cardiac damage after acute ischemic stroke. This "bridge" therapy improved patient outcomes compared to direct thrombectomy alone.
Area of Science:
- Neurology
- Cardiology
- Interventional Medicine
Background:
- Stroke-heart syndrome involves cardiac issues following brain injury from major vessel occlusion.
- Cardiac biomarkers like troponin can indicate stroke-related heart damage.
- The study explores thrombolysis as a potential treatment to mitigate this syndrome.
Purpose of the Study:
- To investigate the ancillary effect of thrombolysis in reducing Stroke-Heart Syndrome after acute ischemic stroke.
- To compare cardiac biomarker levels and functional outcomes between different treatment strategies.
Main Methods:
- Retrospective analysis of 120 acute ischemic stroke patients with anterior circulation occlusion.
- Patients were divided into two groups: "Bridge" (thrombolysis + thrombectomy) and "Direct" (thrombectomy only).
- Exclusion criteria included prior ischemic heart disease.
Main Results:
- The "Bridge" group (92 patients) showed significantly lower peak troponin (16 vs 45 ng/L) and BNP (455 vs 784 pg/mL) levels within 72 hours.
- Functional independence at discharge (mRS 0-2) was significantly higher in the "Bridge" group (36% vs 10%).
- No significant differences were observed in age, baseline NIHSS, or cardiovascular risk factors between groups.
Conclusions:
- The "Bridge" approach (thrombolysis followed by thrombectomy) may reduce cardiac impairment (Stroke-Heart Syndrome) after acute ischemic stroke.
- This combined therapy appears to improve neurological outcomes and functional independence.
- Thrombolysis may have a complementary protective effect on the heart during stroke treatment.
Introduction:
Stroke-heart syndrome is a physiopathological condition of cardiac suffering due to cerebral injury secondary to major vessel occlusion in anterior circulation. It can be detected by increase in cardiac blood biomarkers. Our aim was to investigate a possible ancillary effect of thrombolysis in mitigating Stroke-Heart Syndrome after acute ischaemic stroke.
Patients And Methods:
We retrospectively collected ischaemic stroke patients admitted to our Stroke Unit between August 1, 2017 and December 31, 2020 and acutely treated for an intracranial anterior circulation occlusion, without anamnestic ischaemic cardiopathy. We divided patients into Group B ("Bridge") including patients treated with both thrombolysis and thrombectomy and Group D ("Direct") including primary thrombectomies.
Results:
120 patients were included in the study. Group B consisted of 92 patients, Group D of 28 patients, without significant differences in age, baseline and discharge NIHSS, cardiovascular risk factors or TOAST aetiology. Whilst admission, troponin levels were similar in both groups, significant differences in troponin peak (median 16 ng/L in Group B vs 45 ng/L in Group D, p = 0.022) and BNP values (median 455 pg/mL in Group B vs 784 pg/mL in Group D, p = 0.031) were found in the first 72 h since admission. Functional independence at discharge was significantly higher in Group B than Group D (mRS 0-2 36% vs 10%, p = 0.011).
Discussion And Conclusion:
Significant differences in troponin peak and BNP values suggest a reduced stroke-related heart impairment in patients treated with bridge therapeutic approach: thrombolysis prior to thrombectomy could have a complementary effect on reducing Stroke-Heart Syndrome, improving overall neurological outcome.
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