title: Ischemic stroke subtype is associated with outcome in thrombolyzed patients.
abstract: OBJECTIVE
  The impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is sparsely examined. We studied the association between stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-evaluated patients treated with IV-tPA.
  
  
  METHODS
  We conducted a single-center retrospective analysis of MRI-selected stroke patients treated with IV-tPA between 2004 and 2010. The Trial of ORG 10172 in Acute Stroke Treatment criteria were used to establish the stroke subtype by 3 months. The outcomes of interest were a 3-month modified Rankin Scale score of 0-1 (favorable outcome), and early neurological improvement defined as complete remission of neurological deficit or improvement of ≥4 on the National Institute of Health Stroke Scale at 24 h. The outcomes among stroke subtypes were compared with multivariable logistic regression.
  
  
  RESULTS
  Among 557 patients, 202 (36%) had large vessel disease (LVD), 153 (27%) cardioembolic stroke (CE), 109 (20%) small vessel disease, and 93 (17%) were of other or undetermined etiology. Early neurological improvement was present in 313 (56.4%) patients, and 361 (64.8%) patients achieved a favorable outcome. Early neurological improvement and favorable outcome were more likely in CE patients compared with LVD patients (odds ratio (OR), 2.1 (95% confidence interval, 1.4-3.3), and 2.0 (95% confidence interval, 1.2-3.3), respectively).
  
  
  CONCLUSIONS
  Cardioembolic stroke patients were more likely to achieve early neurological improvement and favorable outcome compared with LVD stroke following MRI-based IV-tPA treatment. This finding may reflect a difference in the effect of IV-tPA among stroke subtypes.
authors.affiliation: Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Schmitz
authors.affiliation: Departments of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: C Z
authors.initials: CZ
authors.lastname: Simonsen
authors.affiliation: Departments of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Svendsen
authors.affiliation: Departments of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Larsson
authors.affiliation: Departments of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M H
authors.initials: MH
authors.lastname: Madsen
authors.affiliation: Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: I K
authors.initials: IK
authors.lastname: Mikkelsen
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Departments of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S P
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: Departments of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: G
authors.initials: G
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute ischemic stroke; ischemic stroke etiology; prognosis; stroke MRI; tissue plasminogen activator