Intravenous thrombolysis for acute ischemic stroke occurring during hospitalization for transient ischemic attack

Authors

  • Georgios Tsivgoulis,

    Corresponding author
    1. Second Department of Neurology, School of Medicine, University of Athens, Athens, Greece
    2. Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece
    3. International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic
    • Correspondence: Georgios Tsivgoulis, Department of Neurology, Democritus University of Thrace, Kapodistriou 3, Nea Xili, Alexandroupolis 68100, Greece.

      E-mail: tsivgoulisgiorg@yahoo.gr

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  • Vijay K. Sharma,

    1. Division of Neurology, Department of Medicine, National University Hospital, Singapore
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  • Robert Mikulik,

    1. International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic
    2. Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • Christos Krogias,

    1. Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany
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  • Michal Haršány,

    1. International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic
    2. Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • Reza Bavarsad Shahripour,

    1. Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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  • Dimitrios Athanasiadis,

    1. Vascular Unit, Third Department of Surgery, School of Medicine, University of Athens, Athens, Greece
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  • Hock Luen Teoh,

    1. Division of Neurology, Department of Medicine, National University Hospital, Singapore
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  • Charitomeni Piperidou,

    1. Second Department of Neurology, School of Medicine, University of Athens, Athens, Greece
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  • Andrei V. Alexandrov

    1. Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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  • Conflict of interest: The authors report no conflicts of interest.

Abstract

Background

There are limited data regarding the use of intravenous thrombolysis in patients who experienced acute ischemic symptoms during their hospitalization for prior transient ischemic attack.

Aim

We sought to prospectively evaluate the safety and efficacy of intravenous thrombolysis for the treatment of acute ischemic stroke occurring during hospitalization for transient ischemic attack in an international, multicenter study.

Methods

Consecutive patients with acute ischemic stroke that occurred during hospitalization for prior transient ischemic attack were treated with intravenous thrombolysis in five tertiary-care stroke centers. Early arterial recanalization was determined by transcranial Doppler at the end of recombinant tissue plasminogen activator infusion using previously validated criteria. Symptomatic intracranial hemorrhage complicating intravenous thrombolysis was evaluated using the National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study definition. Functional independence at three-months was defined as Modified Rankin Scale score of 0–2.

Results

Systemic recombinant tissue plasminogen activator infusion (median onset-to-treatment time 70 mins, interquartile range 50–150) was given in 25 consecutive patients (mean age 66 ± 10 years) who developed acute ischemic stroke symptoms (median National Institutes of Health Stroke Scale score 10 points; interquartile range 8–14) during hospitalization for prior transient ischemic attack (median ABCD2 score 5 points; median time-to-symptom recurrence 24 h, interquartile range 24–48). No symptomatic intracranial hemorrhage (0%; 95% confidence interval 0–12%) was documented. Early complete recanalization occurred in 64% of patients (95% confidence interval 44–80%), and 84% (95% confidence interval 65–94%) achieved three-month functional independence. The rate of three-month functional independence was higher in patients treated with intravenous tissue plasminogen activator within 90 mins from symptom onset compared with those with onset-to-treatment time>90 mins (81% vs. 33%; P = 0·031).

Conclusions

Intravenous thrombolysis for symptoms of acute ischemic stroke occurring after hospitalization for transient ischemic attack appears to be safe. These pilot data support resetting the clock if new symptoms recur shortly after transient ischemic attack.

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