title: Efficacy of intravenous thrombolysis according to stroke subtypes: the Madrid Stroke Network data.
abstract: OBJECTIVE
  To identify possible differences in the early response to intravenous thrombolysis (IVT) or in stroke outcome at 3 months, based on stroke subtype in patients with acute ischaemic stroke (IS).
  
  
  METHODS
  Multicentre stroke registry data were used, with prospective inclusion of consecutive patients with acute IVT-treated IS in five acute stroke units. We compared clinical improvement (National Institutes of Health Stroke Scale, NIHSS) at 24 h and at day 7 as well as functional outcome at 3 months (Modified Rankin Scale, mRS) amongst the different stroke subtypes (ICD-10).
  
  
  RESULTS
  In total, 1479 patients were included; 178 (12%) had large vessel disease (LVD) with carotid stenosis ≥ 50%, 175 (11.8%) had other LVD, 638 (43%) had cardioembolism, 60 (4.1%) had lacunar infarction, 72 (4.9%) were patients with IS of other/unusual cause and 356 (24.1%) had unknown/multiple causes. Patients with lacunar infarction had lower stroke severity (median NIHSS 6) whilst cardioembolic IS was the most severe (median NIHSS 14) (P < 0.001). No differences in NIHSS improvement were found at 24 h. LVD patients with carotid stenosis (odds ratio 0.544; 95% CI 0.383-0.772; P = 0.001) were less likely to improve at day 7 after adjustment for age, gender, vascular risk factors and stroke severity. However, adjusted multivariate analysis showed no influence of stroke subtype on stroke outcome (mRS) at 3 months. Age, systolic blood pressure on admission and stroke severity were independently associated with mRS > 2 at 3 months.
  
  
  CONCLUSIONS
  Although LVD patients with arterial stenosis ≥ 50% improve less than the other aetiologies at day 7, stroke aetiological subtype does not determine differences in IS outcome at 3 months after IVT.
authors: Stroke Center, Department of Neurology and Neuroscience Research Area, IdiPAZ Health Research Institute, La Paz University Hospital, UAM, Madrid, Spain. blfuentesg@hotmail.com
authors: B
authors: B
authors: Fuentes
authors: P
authors: P
authors: Martínez-Sánchez
authors: M
authors: M
authors: Alonso de Leciñana
authors: J
authors: J
authors: Egido
authors: G
authors: G
authors: Reig-Roselló
authors: F
authors: F
authors: Díaz-Otero
authors: V
authors: V
authors: Sánchez
authors: P
authors: P
authors: Simal
authors: A
authors: A
authors: Ximenez-Carrillo
authors: A
authors: A
authors: García-Pastor
authors: G
authors: G
authors: Ruiz-Ares
authors: A
authors: A
authors: García-García
authors: J
authors: J
authors: Masjuan
authors: J
authors: J
authors: Vivancos-Mora
authors: A
authors: A
authors: Gil-Nuñez
authors: E
authors: E
authors: Díez-Tejedor
mesh_terms: D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D020127:Recovery of Function; D012042:Registries; D013030:Spain; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator