PMID- 32277039
OWN - NLM
STAT- MEDLINE
DCOM- 20210126
LR  - 20210126
IS  - 1759-8486 (Electronic)
IS  - 1759-8478 (Linking)
VI  - 12
IP  - 11
DP  - 2020 Nov
TI  - Early neurologic decline in acute ischemic stroke patients receiving thrombolysis 
      with large vessel occlusion and mild deficits.
PG  - 1085-1087
LID - 10.1136/neurintsurg-2020-015871 [doi]
AB  - BACKGROUND: We sought to determine the rate of early neurologic decline (END) in 
      patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) who 
      presented with mild deficits and received intravenous tissue plasminogen 
      activator (IVtPA). METHODS: Among 1022 patients with AIS who received IVtPA from 
      2014 to 2019, we identified 313 (30.6%) with LVO, of which 94 (30%) presented 
      with National Institute of Health Stroke Scale (NIHSS) score </=7. Thirteen 
      patients were excluded, leaving 81 for analysis. END was defined as NIHSS 
      worsening of >/=4 points within 24 hours. RESULTS: Among 81 patients with LVO and 
      low NIHSS score, the mean age was 65.8 years (range 25-93) and 41% were female. 
      The mean time to IVtPA from last known well was 2.5 hours (range 0.8-7). LVO 
      sites were as follows: 5 (6%) carotid, 23 (28%) M1, and 53 (65%) M2 occlusions. 
      Among the 81 patients, 28 (34.6%) had END, and these patients were older (70.8 vs 
      63.2 years, p=0.036). The mean change in NIHSS score at 24 hours in those with 
      END was 10.4 (range 4-22). Patients with END were less likely to be discharged 
      home (25% vs 66%, p=0.004). CONCLUSIONS: Among patients with LVO AIS who received 
      IVtPA, 30% presented with initial mild deficits. END occurred in one-third of LVO 
      patients with initial mild deficits despite receiving IVtPA. Clinicians should be 
      aware that the natural history of LVO with initial mild deficits is not benign 
      and these patients are eligible for rescue thrombectomy in the 24-hour window if 
      they deteriorate.
CI  - (c) Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Lee, Vivien H
AU  - Lee VH
AD  - Department of Neurology, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA vivien.lee@osumc.edu.
FAU - Thakur, Gaurav
AU  - Thakur G
AD  - Department of Neurology, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA.
FAU - Nimjee, Shahid M
AU  - Nimjee SM
AD  - Department of Neurosurgery, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA.
FAU - Youssef, Patrick P
AU  - Youssef PP
AD  - Department of Neurosurgery, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA.
FAU - Lakhani, Sushil
AU  - Lakhani S
AD  - Department of Neurology, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA.
FAU - Heaton, Sharon
AU  - Heaton S
AD  - Department of Neurology, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA.
FAU - Powers, Ciaran J
AU  - Powers CJ
AD  - Department of Neurosurgery, The Ohio State University Wexner Medical Center, 
      Columbus, Ohio, USA.
LA  - eng
PT  - Journal Article
DEP - 20200410
PL  - England
TA  - J Neurointerv Surg
JT  - Journal of neurointerventional surgery
JID - 101517079
RN  - 0 (Fibrinolytic Agents)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Brain Ischemia/diagnostic imaging/*drug therapy
MH  - Cerebrovascular Disorders/diagnostic imaging/*drug therapy
MH  - Cognitive Dysfunction/diagnostic imaging/*drug therapy
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Humans
MH  - Ischemic Stroke/diagnostic imaging/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Nervous System Diseases
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Thrombolytic Therapy/*methods
MH  - Tissue Plasminogen Activator/*therapeutic use
OTO - NOTNLM
OT  - stroke
OT  - thrombectomy
OT  - thrombolysis
COIS- Competing interests: None declared.
EDAT- 2020/04/12 06:00
MHDA- 2021/01/27 06:00
CRDT- 2020/04/12 06:00
PHST- 2020/01/30 00:00 [received]
PHST- 2020/03/12 00:00 [revised]
PHST- 2020/03/16 00:00 [accepted]
PHST- 2020/04/12 06:00 [pubmed]
PHST- 2021/01/27 06:00 [medline]
PHST- 2020/04/12 06:00 [entrez]
AID - neurintsurg-2020-015871 [pii]
AID - 10.1136/neurintsurg-2020-015871 [doi]
PST - ppublish
SO  - J Neurointerv Surg. 2020 Nov;12(11):1085-1087. doi: 
      10.1136/neurintsurg-2020-015871. Epub 2020 Apr 10.