Factors associated with early improvement after intravenous thrombolytic treatment in acute ischemic stroke

ABSTRACT

Objective

: The aim of this study was to determine the factors associated with early neurological improvement (ENI) in patients who experienced acute ischemic stroke and were treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), and determine the relationship with the outcome at the first control.

Method

: This study included 377 patients who were treated with IV rt-PA in Izmir Dokuz Eylül University Hospital between January 2010 and October 2018. ENI was defined as a 4 or more improvement in the National Institutes of Health Stroke Scale (NIHSS) score in the first hour, the twenty-fourth hour and the seventh day when compared to the pretreatment phase. The modified Rankin Scale (mRS) 0–1 score was defined as ‘very good outcome’.

Results

: The basal NIHSS (p=0.003, p=0.003, p=0.022) was high in the first hour, twenty-fourth hour, and seventh day ENI groups. Blood urea nitrogen (BUN) level was low in the first- and twenty-fourth-hour ENI groups (p=0.007, p=0.020). Furthermore, admission glucose was low at the twenty-fourth hour and on the seventh day ENI groups (p=0.005, p=0.048). A high infarct volume was observed on magnetic resonance imaging (MRI) at the twenty-fourth hour and on the seventh day non-ENI groups (p= <0.001, p= <0.001).

Conclusion

: Management of factors associated with ENI and determination of treatment strategies accordingly are important for obtaining a better clinical outcome. It can help quickly select patients, who, even though they will not respond to rt-PA, may be appropriate candidates for bridging therapy.

KEYWORDS:

• Stroke
• intravenous thrombolytic therapy
• early recovery
• recovery
• acute ischemic stroke

Acknowledgments

We thank Professor M.D. Hulya Ellidokuz (Dokuz Eylül University Faculty of Medicine, Department of Preventive Oncology, Institute of Oncology) for her assistance with statistical analysis of the variables.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Complementary informations; declarations

Consent of data acquisition: The study was conducted by obtaining permission to access patient file archive materials and hospital system records.

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Nurcan Akbulut, Vesile Ozturk, Suleyman Men, Atakan Arslan, Zeynep Tuncer Issı, Erdem Yaka, Kursad Kutluk. The first draft of the manuscript was written by Nurcan Akbulut and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Conflict of Interest: Authors have no conflicts of interest to declare.

The authors did not receive support from any organization for the submitted work.

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Dokuz Eylül University Non-Interventional Research (4324 – GOA – 2018/27-01).

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. This manuscript proofread and edited by True Editors with job ID 14634 and number 1,620,131,427.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Nurcan Akbulut

Nurcan Akbulutcompleted her Neurology specialization at Dokuz Eylul University Faculty of Medicine and worked as a specialist at Bayburt State Hospital. Her areas of interest are cerebrovascular disease and headache.

Vesile Ozturk

Vesile Ozturkis a professor of Dokuz Eylul University Faculty of Medicine, Department of Neurology. Her work focuses specifically on the cerebrovascular disease and headache.

Suleyman Men

Suleyman Menis a professor of Dokuz Eylul University Faculty of Medicine, Department of Radiology. His area of interest is neurological interventional therapy.

Atakan Arslan

Atakan Arslancompleted his Radiology specialization at Dokuz Eylul University Faculty of Medicine and he is currently working at the Başkent University Hospital Izmir.

Zeynep Tuncer Issı

Zeynep Tuncer Issıcompleted her Neurology and Pain specialization at Dokuz Eylul University Faculty of Medicine and she is currently working at the Sakarya Research and Training Hospital Neurology and Pain Management Clinic. Her work focuses specifically on the intervention techniques for pain relief and medical treatment.

Erdem Yaka

Erdem Yakais a professor of Dokuz Eylul University Faculty of Medicine, Department of Neurology. His work focuses specifically on the cerebrovascular disease and neurological intensive care.

Kursad Kutluk

Kursad Kutlukis a professor of Dokuz Eylul University Faculty of Medicine, Department of Neurology. His work focuses specifically on the cerebrovascular disease.