title: Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study.
abstract: The impact of intravenous recombinant tissue plasminogen activator (IV-rtPA) in patients with acute ischaemic stroke (AIS) but no arterial occlusion is currently a matter of debate. This study aimed to assess functional outcome of such patients with respect to IV-rtPA use.
  
  
  
  A retrospective case-control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV-rtPA use. Patients were selected from prospective consecutive observational registries of five European university hospitals. The primary study outcome was excellent outcome at 3 months after stroke, as defined by a modified Rankin Scale (mRS) 0-1.
  
  
  
  A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV-rtPA and 188 did not. No between-group difference was found for excellent outcome before and after adjustment for baseline characteristics (adjusted odds ratio for no IV-rtPA use 0.79, 95% confidence interval 0.51-1.24, P = 0.31). Similar results were found for favourable outcome (defined as a 90-day mRS of 0-2) whereas a higher rate of early neurological improvement was found in IV-rtPA-treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29-3.07, P = 0.002). Sensitivity analyses yielded similar results.
  
  
  
  Our study suggests that AIS patients without visible arterial occlusion treated with IV-rtPA may have no better outcome at 3 months than those untreated. However, only a randomized controlled trial would provide a definitive answer about the impact of rtPA in acute stroke patients without occlusion. Until then, these patients should be treated by rtPA as recommended.
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: N
authors.initials: N
authors.lastname: Ajili
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Decroix
authors.affiliation: Laboratoire de Mathématiques Paul Painlevé, UMR CNRS 8524, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Preda
authors.affiliation: Department of Biostatistics, Lille University Medical Centre, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Labreuche
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: D
authors.initials: D
authors.lastname: Lopez
authors.affiliation: Department of Neurology, University Hospital and Medical School of Dijon, Dijon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bejot
authors.affiliation: Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.affiliation: Department of Neurology, Nantes University Hospital, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Sévin-Allouet
authors.affiliation: Université Bordeaux 2, CHU Bordeaux, Pole de Neurosciences Cliniques, Unité neuro-vasculaire, Bordeaux, France.
authors.forename: I
authors.initials: I
authors.lastname: Sibon
authors.affiliation: Université Bordeaux 2, CHU Bordeaux, Pole de Neurosciences Cliniques, Unité neuro-vasculaire, Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Vergnet
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: A
authors.initials: A
authors.lastname: Wang
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: N
authors.initials: N
authors.lastname: Sanda
authors.affiliation: Department of Neurology and Stroke Centre, Lariboisière Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mazighi
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: F
authors.initials: F
authors.lastname: Bourdain
authors.affiliation: Division of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: B
authors.initials: B
authors.lastname: Lapergue
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: arterial occlusion; ischaemic stroke; outcome; thrombolysis