NEW ORLEANS—Thrombolysis did not affect the functional outcome of patients with ischemic stroke who presented without vascular occlusion, according to research reported at the 64th Annual Meeting of the American Academy of Neurology. The treatment did not affect these patients’ NIH Stroke Scale (NIHSS) scores, but entailed a risk of intracerebral bleeding.
Retrospectively Comparing Outcomes
Patients may present without vascular occlusion when the embolus disintegrates spontaneously or when they have lacunar stroke. To determine whether thrombolysis is beneficial in these instances, Sourabh Lahoti, MBBS, clinical research assistant at Beth Israel Deaconess Medical Center in Boston, and colleagues retrospectively analyzed medical records of patients with ischemic stroke and no imaging evidence of vascular occlusion. All patients had been treated at the medical center during the previous five years. The investigators divided the patients into a group that received thrombolysis and a group that did not. Based on infarct size and location, the investigators further categorized the patients as having had spontaneous recanalization of emboli or lacunar stroke.
Dr. Lahoti found no difference in NIHSS score between thrombolyzed and nonthrombolyzed patients at presentation, at seven days, and at 90 days. The change in NIHSS score from presentation to seven days and to 90 days was not significantly different between the two groups of patients.
Nearly 17% of asymptomatic patients who were thrombolyzed developed intracerebral bleeding. The rate of mortality among thrombolyzed patients was 8.3%, and the patients’ deaths did not result from cerebrovascular causes.
A Prospective Study Could Provide More Clinical Guidance
“The only thing that t-PA does is lyse clots. So, if there’s no thrombosis and there are no clots, it’s really unlikely that the drug would work,” said Louis R. Caplan, MD, Professor of Neurology at Harvard Medical School in Boston. Clinicians can evaluate blood vessels quickly and noninvasively with studies such as neck ultrasound, transcranial Doppler, computed tomography angiography, and magnetic resonance angiography. “Then, theoretically you might not give thrombolytics if there was no clot,” added Dr. Caplan, who was a coauthor of the study.
A large, prospective study would clarify the value of thrombolysis for patients with stroke who present without vascular occlusion, said Dr. Caplan. One group of patients would receive thrombolysis, and the other would not, and outcomes could be compared.
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