title: Influence of arterial occlusion on outcome after intravenous thrombolysis for acute ischemic stroke.
abstract: OBJECTIVE
  We aimed to assess the interaction between intravenous thrombolysis (IVT) and arterial occlusion on acute cervicocerebral computed tomographic angiography on the outcome of patients with acute ischemic stroke.
  
  
  METHODS
  Patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry with onset-to-door-time ≤4 hours, acute cervicocerebral computed tomographic angiography, a premorbid modified Rankin Scale ≤2, and a National Institute of Health Stroke Scale (NIHSS) >4 were selected. Patients with significant intracranial arterial obstruction (≥50%-99%) and undergoing acute endovascular treatment were excluded. An interaction analysis of IVT and initial arterial occlusion for favorable 3 months outcome (modified Rankin Scale <3) were performed with adjustment for potential confounders.
  
  
  RESULTS
  Among 654 included patients, 382 (58%) showed arterial occlusion, of whom 263 (69%) received IVT. Two hundred seventy-two showed no/minimal obstruction of whom 139 (51%) received IVT. In the adjusted interaction analysis, there was a trend in favor of the arterial occlusion group (odds ratio [OR]=3.97; 95% confidence interval [CI], 0.83-18.97; P=0.08). IVT (versus no IVT) was associated with better outcome in patients with occlusion (adjusted OR for favorable outcome, 3.01; 95% CI, 1.10-8.28) but not in patients with no/minimal obstruction (OR, 0.76; 95% CI, 0.21-2.74). Conversely, patients with occlusion had a similar rate of favorable outcome as no/minimal obstruction when thrombolysed (OR, 0.5; 95% CI, 0.17-1.47) but had a less favorable outcome without thrombolysis (OR, 0.13; 95% CI, 0.04-0.44).
  
  
  CONCLUSIONS
  In this retrospective analysis of consecutive patients with acute ischemic stroke, there was a trend for more favorable outcomes with IVT in the setting of initial arterial occlusion than in the setting of no/minimal obstruction. Before confirmation in randomized controlled studies, this information should not influence thrombolysis decisions, however.
authors.affiliation: From the Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (F.M., P.M.); Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (M.A.); Department of Neurology, University Hospital Antwerp, Belgium (P.V.); and University of Lausanne, Lausanne, Switzerland (P.M.). friedrich.medlin@h-fr.ch.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Medlin
authors.affiliation: From the Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (F.M., P.M.); Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (M.A.); Department of Neurology, University Hospital Antwerp, Belgium (P.V.); and University of Lausanne, Lausanne, Switzerland (P.M.).
authors.forename: Michael
authors.initials: M
authors.lastname: Amiguet
authors.affiliation: From the Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (F.M., P.M.); Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (M.A.); Department of Neurology, University Hospital Antwerp, Belgium (P.V.); and University of Lausanne, Lausanne, Switzerland (P.M.).
authors.forename: Peter
authors.initials: P
authors.lastname: Vanacker
authors.affiliation: From the Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (F.M., P.M.); Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (M.A.); Department of Neurology, University Hospital Antwerp, Belgium (P.V.); and University of Lausanne, Lausanne, Switzerland (P.M.).
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: patient outcome assessment; stroke; thrombolytic therapy; tissue-type plasminogen activator