The impact of lesion side on acute stroke treatment.
BACKGROUND
Only a small percentage of patients with acute stroke are treated with recombinant tissue plasminogen activator (rt-PA).


OBJECTIVE
To investigate why patients with right-hemisphere strokes seem at high risk of not receiving rt-PA.


METHODS
This study includes two phases. Phase 1: the authors compared demographic, clinical, and outcome measures between patients with right- and left-hemisphere strokes in the rt-PA Registry of Southwestern Ontario (RSWO); Phase 2: the authors tested the hypotheses generated in Phase 1 using the Registry of the Canadian Stroke Network (RCSN). A multiple logistic analysis was applied to detect independent predictors of rt-PA administration.


RESULTS
Phase 1: of 179 rt-PA-treated patients, 39% had right-hemisphere syndrome. Patients with right-hemisphere strokes had a longer hospital stay (15 vs 9 days; p = 0.03). Phase 2: of 990 stroke patients in the RCSN, 505 (51%) had a right- and 485 (49%) a left-hemisphere syndrome. Of 110 rt-PA-treated patients, 37 (34%) had a right-hemisphere syndrome (p = 0.0001). Negative independent predictors of rt-PA administration were right-hemisphere stroke (OR, 0.55; CI: 0.31 to 0.96; p = 0.037), onset-to-emergency department time (OR, 0.99; CI 0.98 to 0.99; p = 0.04), and CNS score (OR, 0.78; CI 0.71 to 0.86; p < 0.0001). Neglect predicted rt-PA administration (OR, 2.32; CI 1.29 to 4.16; p = 0.004).


CONCLUSIONS
Patients with right-hemisphere strokes are 45% less likely to be treated with recombinant tissue plasminogen activator (rt-PA) compared to patients with left-hemisphere strokes. The presence of neglect confers a twofold increased likelihood of rt-PA administration. Prehospital delay and lack of standardized scores for the neglect syndrome may limit accessibility of patients with right-hemisphere stroke to thrombolysis.
Di Legge
Silvia
S
Department of Clinical Neurological Sciences, London Health Science Centre, University of Western Ontario, Canada. sdilegge@uwo.ca
Fang
Jiming
J
Saposnik
Gustavo
G
Hachinski
Vladimir
V
D000208:Acute Disease / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data* / Q000639:trends*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator