Personified Approaches to Reperfusion Therapy of Ischemic Stroke
- Authors: Domashenko M.A.1, Maksimova M.Y.2, Gafarova M.E.3, Tanashyan M.M.2, Antonova K.V.2, Piradov M.A.2
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Affiliations:
- Botkin City Clinical Hospital
- Research Center of Neurology
- Vorokhobov City Clinical Hospital no. 67
- Issue: Vol 44, No 8 (2018)
- Pages: 869-874
- Section: Article
- URL: https://journals.rcsi.science/0362-1197/article/view/177984
- DOI: https://doi.org/10.1134/S0362119718080030
- ID: 177984
Cite item
Abstract
Introduction: Systemic thrombolytic therapy (STLT) with recombinant tissue plasminogen activator (rtPA) is the “gold standard” of reperfusion therapy in certain patients with ischemic stroke during the first 4.5 h after stroke onset. Objective: To assess the clinical (severity of neurological symptoms) and laboratory (complete blood cell count test) factors that affect the disease outcome after STLT. Materials and methods: Seventy patients (48 males and 22 females) aged 61 [54; 69] years with ischemic stroke who received rtPA therapy at a dose of 0.9 mg/kg were prospectively studied. Blood for the complete blood count test including neutrophil and lymphocyte counts was sampled before the thrombolytic therapy. The severity of neurological impairment was assessed using the NIH Stroke Scale (NIHSS). The functional outcome was assessed 3 months after stroke with the modified Rankin scale (mRS). ROC analysis was used to reveal factors of unfavorable outcome in acute phase of ischemic stroke (mRS score ≥ 3). Results: Severity of neurological deficit was assessed according to the NIHSS at admission was 15 [11; 17] points. Time between the manifestation of neurological symptoms and admission to the hospital was 138 [117; 170] min, and time between admission and initiation of STLT (the door-to-needle time), was 40 [30; 55] min. An unfavourable functional outcome of systemic thrombolytic therapy can be predicted according to the results of ROC analysis: the NIHSS score upon admission 12 or higher (sensitivity, 94%; specificity, 57%); neutrophil count, >7.8 × 109/L (sensitivity, 45.5%; specificity, 90.6%); lymphocyte count < 1.8 × 109/L (sensitivity, 81.8%; specificity, 59.4%). Conclusions: Personalized approach to systemic thrombolytic therapy may help to predict its effectiveness and contribute the development of more reliable strategies of patient management. Patients with potentially unfavorable outcome after intravenous thrombolysis can be the target group for mechanical reperfusion techniques such as thrombus extraction.
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About the authors
M. A. Domashenko
Botkin City Clinical Hospital
Author for correspondence.
Email: mdomashenko@gmail.com
Russian Federation, Moscow, 125284
M. Yu. Maksimova
Research Center of Neurology
Email: mdomashenko@gmail.com
Russian Federation, Moscow, 125367
M. E. Gafarova
Vorokhobov City Clinical Hospital no. 67
Email: mdomashenko@gmail.com
Russian Federation, Moscow
M. M. Tanashyan
Research Center of Neurology
Email: mdomashenko@gmail.com
Russian Federation, Moscow, 125367
K. V. Antonova
Research Center of Neurology
Email: mdomashenko@gmail.com
Russian Federation, Moscow, 125367
M. A. Piradov
Research Center of Neurology
Email: mdomashenko@gmail.com
Russian Federation, Moscow, 125367