Difficult questions of intravenous thrombolytic therapy in ischemic stroke
- Authors: Kulesh A.A.1
-
Affiliations:
- Wagner Perm State Medical University
- Issue: Vol 23, No 11 (2021)
- Pages: 805-813
- Section: Articles
- URL: https://journals.rcsi.science/2075-1753/article/view/96606
- DOI: https://doi.org/10.26442/20751753.2021.11.201143
- ID: 96606
Cite item
Full Text
Abstract
The article reflects the current achievements in the field of reperfusion therapy for ischemic stroke. The data are presented that allow a practicing neurologist to make informed decisions about intravenous thrombolysis in difficult clinical situations: minor stroke, suspected stroke "mask", atypical clinical picture, patient's age over 80 years, posterior circulation stroke, isolated dizziness, severe neurological deficit, large artery occlusion, chronic neuroimaging changes, polymorbidity and low functional level before stroke. It has been shown that an increase in the number of candidates for intravenous thrombolysis can be achieved by intensifying the selection of patients within the 4.5-hour therapeutic window, which primarily implies the optimization of local stroke treatment protocols with a reduction in the door-to-needle time, as well as, in the short term, expanding the therapeutic window. Approaches to reduce the risk of symptomatic hemorrhagic transformation are discussed. We are also talking about a rare but life-threatening complication – angioedema. Thus, the intensification of intravenous thrombolysis, as well as an increase in its effectiveness and safety are the primary tasks of each stroke department.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
Aleksey A. Kulesh
Wagner Perm State Medical University
Author for correspondence.
Email: aleksey.kulesh@gmail.com
ORCID iD: 0000-0001-6061-8118
D. Sci. (Med.), Assoc. Prof.
Russian Federation, PermReferences
- Pan Y, Shi G. Silver Jubilee of Stroke Thrombolysis With Alteplase: Evolution of the Therapeutic Window. Front Neurol. 2021;12:593887. doi: 10.3389/fneur.2021.593887
- National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7. doi: 10.1056/NEJM199512143332401
- Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708-18. doi: 10.1056/NEJMoa1713973
- Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378(1):11-21. doi: 10.1056/NEJMoa1706442
- Grigoryan M, Haussen DC, Hassan AE, et al. Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review. Cerebrovasc Dis. 2016;41(5-6):306-12. doi: 10.1159/000444069
- Brinster CJ, Sternbergh WC 3rd. Safety of urgent carotid endarterectomy following thrombolysis. J Cardiovasc Surg (Torino). 2020;61(2):149-58. doi: 10.23736/S0021-9509.20.11179-0
- Баркова Т.В., Алашеев А.М., Белкин А.А., и др. Эффективность и безопасность телетромболизиса при открытии нового первичного сосудистого отделения. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2018;118(12-2):70-4 [Barkova TV, Alasheev AM, Belkin AA, et al. The efficacy and safety of telethrombolysis in a newly opened stroke unit. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Spetsvypuski. 2018;118(12-2):70-4 (in Russian)]. doi: 10.17116/jnevro201811812270
- Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1):I-LXII. doi: 10.1177/2396987321989865
- Moulin S, Leys D. Stroke mimics and chameleons. Curr Opin Neurol. 2019;32(1):54-9. doi: 10.1097/WCO.0000000000000620
- Willenberg R, Leung B, Song S, et al. Munchausen Syndrome by Tissue Plasminogen Activator: Patients Seeking Thrombolytic Administration. Neurol Clin Pract. 2021;11(1):64-8. doi: 10.1212/CPJ.0000000000000828
- Zinkstok SM, Engelter ST, Gensicke H, et al. Safety of thrombolysis in stroke mimics: results from a multicenter cohort study. Stroke. 2013;44(4):1080-4. doi: 10.1161/STROKEAHA.111.000126
- Ali-Ahmed F, Federspiel JJ, Liang L, et al. Intravenous Tissue Plasminogen Activator in Stroke Mimics. Circ Cardiovasc Qual Outcomes. 2019;12(8):e005609. doi: 10.1161/CIRCOUTCOMES.119.005609
- Lees KR, Emberson J, Blackwell L, et al.; Stroke Thrombolysis Trialists’ Collaborators Group. Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes: A Pooled Analysis of 9 Trials. Stroke. 2016;47(9):2373-9. doi: 10.1161/STROKEAHA.116.013644
- Wang X, Robinson TG, Lee TH, et al.; Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) Investigators. Low-Dose vs Standard-Dose Alteplase for Patients With Acute Ischemic Stroke: Secondary Analysis of the ENCHANTED Randomized Clinical Trial. JAMA Neurol. 2017;74(11):1328-35. doi: 10.1001/jamaneurol.2017.2286
- Arora R, Salamon E, Katz JM, et al. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke. 2016;47(9):2347-54. doi: 10.1161/STROKEAHA.116.012241
- Fischer U, Baumgartner A, Arnold M, et al. What is a minor stroke? Stroke. 2010;41(4):661-6. doi: 10.1161/STROKEAHA.109.572883
- Khatri P, Conaway MR, Johnston KC; Acute Stroke Accurate Prediction Study (ASAP) Investigators. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke. Stroke. 2012;43(2):560-2. doi: 10.1161/STROKEAHA.110.593897
- Emberson J, Lees KR, Lyden P, et al.; Stroke Thrombolysis Trialists’ Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5
- Romano JG, Smith EE, Liang L, et al. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the Get With the Guidelines-Stroke registry. JAMA Neurol. 2015;72(4):423-31. doi: 10.1001/jamaneurol.2014.4354
- Khatri P, Kleindorfer DO, Devlin T, et al.; PRISMS Investigators. Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial. JAMA. 2018;320(2):156-66. doi: 10.1001/jama.2018.8496
- Inoa V, Aron AW, Staff I, et al. Lower NIH stroke scale scores are required to accurately predict a good prognosis in posterior circulation stroke. Cerebrovasc Dis. 2014;37(4):251-5. doi: 10.1159/000358869
- Sommer P, Seyfang L, Posekany A, et al. Prehospital and intra-hospital time delays in posterior circulation stroke: results from the Austrian Stroke Unit Registry. J Neurol. 2017;264(1):131-8. doi: 10.1007/s00415-016-8330-x
- Olivato S, Nizzoli S, Cavazzuti M, et al. e-NIHSS: an Expanded National Institutes of Health Stroke Scale Weighted for Anterior and Posterior Circulation Strokes. J Stroke Cerebrovasc Dis. 2016;25(12):2953-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.011
- Keselman B, Gdovinová Z, Jatuzis D, et al. Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke: Results From the Safe Implementation of Treatments in Stroke Registry and Meta-Analysis. Stroke. 2020;51(3):876-82. doi: 10.1161/STROKEAHA.119.027071
- Dorňák T, Král M, Šaňák D, Kaňovský P. Intravenous Thrombolysis in Posterior Circulation Stroke. Front Neurol. 2019;10:417. doi: 10.3389/fneur.2019.00417
- Кулеш А.А., Демин Д.А., Гусева А.Л., и др. Вестибулярное головокружение в неотложной неврологии. Российский неврологический журнал. 2021;26(4):50-9 [Kulesh AA, Demin DA, Guseva AL, et al. Vestibular vertigo in emergency neurology. Russian neurological journal. 2021;26(4):50-9 (in Russian)]. doi: 10.30629/2658-7947-2021-26-4-50-59
- Machner B, Choi JH, Neumann A, et al. What guides decision-making on intravenous thrombolysis in acute vestibular syndrome and suspected ischemic stroke in the posterior circulation? J Neurol. 2021;268(1):249-64. doi: 10.1007/s00415-020-10134-9
- Rostanski SK, Shahn Z, Elkind MSV, et al. Door-to-Needle Delays in Minor Stroke: A Causal Inference Approach. Stroke. 2017;48(7):1980-2. doi: 10.1161/STROKEAHA.117.017386
- Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al.; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641. doi: 10.1161/STR.0000000000000086
- Seners P, Turc G, Maïer B, et al. Incidence and Predictors of Early Recanalization After Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. Stroke. 2016;47(9):2409-12. doi: 10.1161/STROKEAHA.116.014181
- Sun H, Liu Y, Gong P, et al. Intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign: A meta-analysis. Acta Neurol Scand. 2020;141(3):193-201. doi: 10.1111/ane.13177
- Kharitonova TV, Melo TP, Andersen G, et al.; SITS investigators. Importance of cerebral artery recanalization in patients with stroke with and without neurological improvement after intravenous thrombolysis. Stroke. 2013;44(9):2513-8. doi: 10.1161/STROKEAHA.111.000048
- Goyal M, Menon BK, van Zwam WH, et al.; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-31. doi: 10.1016/S0140-6736(16)00163-X
- Nogueira RG, Tsivgoulis G. Large Vessel Occlusion Strokes After the DIRECT-MT and SKIP Trials: Is the Alteplase Syringe Half Empty or Half Full? Stroke. 2020;51(10):3182-6. doi: 10.1161/STROKEAHA.120.030796
- Yang P, Zhang Y, Zhang L, et al.; DIRECT-MT Investigators. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med. 2020;382(21):1981-93. doi: 10.1056/NEJMoa2001123
- Wang Y, Wu X, Zhu C, et al. Bridging Thrombolysis Achieved Better Outcomes Than Direct Thrombectomy After Large Vessel Occlusion: An Updated Meta-Analysis. Stroke. 2021;52(1):356-65. doi: 10.1161/STROKEAHA.120.031477
- Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi: 10.1161/STR.0000000000000211
- IST-3 collaborative group. Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial. Lancet Neurol. 2015;14(5):485-96. doi: 10.1016/S1474-4422(15)00012-5
- Huang S, Lu X, Tang LV, Hu Y. Efficacy and safety of intravenous thrombolysis for acute ischemic stroke in cancer patients: a systemic review and meta-analysis. Am J Transl Res. 2020;12(8):4795-806.
- Gensicke H, Strbian D, Zinkstok SM, et al.; Thrombolysis in Stroke Patients (TriSP) Collaborators. Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke. Stroke. 2016;47(2):450-6. doi: 10.1161/STROKEAHA.115.011674
- Nolte CH, Ebinger M, Scheitz JF, et al. Effects of Prehospital Thrombolysis in Stroke Patients With Prestroke Dependency. Stroke. 2018;49(3):646-51. doi: 10.1161/STROKEAHA.117.019060
- Karlinski M, Kobayashi A, Czlonkowska A, et al.; Safe Implementation of Treatments in Stroke–Eastern Europe (SITS-EAST) Investigators. Role of preexisting disability in patients treated with intravenous thrombolysis for ischemic stroke. Stroke. 2014;45(3):770-5. doi: 10.1161/STROKEAHA.113.003744
- Meretoja A, Keshtkaran M, Saver JL, et al. Stroke thrombolysis: save a minute, save a day. Stroke. 2014;45(4):1053-8. doi: 10.1161/STROKEAHA.113.002910
- Fonarow GC, Zhao X, Smith EE, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014;311(16):1632-40. doi: 10.1001/jama.2014.3203
- Man S, Xian Y, Holmes DN, et al. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA. 2020;323(21):2170-84. doi: 10.1001/jama.2020.5697
- Kamal N, Jeerakathil T, Stang J, et al.; QuICR Alberta Stroke Program. Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population. Stroke. 2020;51(8):2339-46. doi: 10.1161/STROKEAHA.120.029734
- Kamal N, Smith EE, Jeerakathil T, Hill MD. Thrombolysis: Improving door-to-needle times for ischemic stroke treatment – A narrative review. Int J Stroke. 2018;13(3):268-76. doi: 10.1177/1747493017743060
- Rimmele DL, Thomalla G. Wake-up stroke: clinical characteristics, imaging findings, and treatment option – an update. Front Neurol. 2014;5:35. doi: 10.3389/fneur.2014.00035
- Campbell BCV, Ma H, Ringleb PA, et al.; EXTEND, ECASS-4, and EPITHET Investigators. Extending thrombolysis to 4.5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019;394(10193):139-47. doi: 10.1016/S0140-6736(19)31053-0
- Thomalla G, Simonsen CZ, Boutitie F, et al.; WAKE-UP Investigators. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med. 2018;379(7):611-22. doi: 10.1056/NEJMoa1804355
- Thomalla G, Boutitie F, Ma H, et al.; Evaluation of unknown Onset Stroke thrombolysis trials (EOS) investigators. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data. Lancet. 2020;396(10262):1574-84. doi: 10.1016/S0140-6736(20)32163-2
- Macha K, Hoelter P, Siedler G, et al. Multimodal CT or MRI for IV thrombolysis in ischemic stroke with unknown time of onset. Neurology. 2020;95(22):e2954-e2964. doi: 10.1212/WNL.0000000000011059
- Wang W, Li M, Chen Q, Wang J. Hemorrhagic Transformation after Tissue Plasminogen Activator Reperfusion Therapy for Ischemic Stroke: Mechanisms, Models, and Biomarkers. Mol Neurobiol. 2015;52(3):1572-9. doi: 10.1007/s12035-014-8952-x
- Jickling GC, Liu D, Stamova B, et al. Hemorrhagic transformation after ischemic stroke in animals and humans. J Cereb Blood Flow Metab. 2014;34(2):185-99. doi: 10.1038/jcbfm.2013.203
- Yaghi S, Willey JZ, Cucchiara B, et al.; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017;48(12):e343-e361. doi: 10.1161/STR.0000000000000152
- Charbonnier G, Bonnet L, Biondi A, Moulin T. Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke. Front Neurol. 2021;11:629920. doi: 10.3389/fneur.2020.629920
- Whiteley WN, Emberson J, Lees KR, et al.; Stroke Thrombolysis Trialists’ Collaboration. Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis. Lancet Neurol. 2016;15(9):925-33. doi: 10.1016/S1474-4422(16)30076-X
- Lou M, Safdar A, Mehdiratta M, et al. The HAT Score: a simple grading scale for predicting hemorrhage after thrombolysis. Neurology. 2008;71(18):1417-23. doi: 10.1212/01.wnl.0000330297.58334.dd
- Sandset EC, Anderson CS, Bath PM, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. Eur Stroke J. 2021;6(2):XLVIII-LXXXIX. doi: 10.1177/23969873211012133
- Fröhlich K, Macha K, Gerner ST, et al. Angioedema in Stroke Patients With Thrombolysis. Stroke. 2019;50(7):1682-7. doi: 10.1161/STROKEAHA.119.025260
- Vigneron C, Lécluse A, Ronzière T, et al. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study. J Intern Med. 2019;286(6):702-10. doi: 10.1111/joim.12962