Vascular Risk Factors in Patients with Different Subtypes of Ischemic Stroke May Affect Their Outcome after Intravenous tPA

Authors

Yi Dong, Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China; INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Wenjie Cao, Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China.
Jinma Ren, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Deepak S. Nair, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Sarah Parker, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Jan L. Jahnel, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Teresa G. Swanson-Devlin, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Judith M. Beck, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Maureen Mathews, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Clayton J. McNeil, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Manas Upadhyaya, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
Yuan Gao, Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Qiang Dong, Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China.
David Z. Wang, INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.Follow

Document Type

Article

Abstract

Intravenous (i.v.) tissue-type plasminogen activator (tPA) is the only approved noninvasive therapy for acute ischemic stroke (AIS). However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with i.v. tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) scores, 90-day modified Rankin Scores (mRS), and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received i.v. tPA, 217 were in the large artery atherosclerosis (LAA) group, 146 in the small vessel occlusion (SVO) group, and 140 in the cardioaortic embolism (CE) group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with i.v. tPA may be related to different vascular risk factors associated with different subtypes of stroke.

Medical Subject Headings

Administration, Intravenous; Aged; Aged, 80 and over; Atherosclerosis (complications); Brain Ischemia (complications, drug therapy); Dyslipidemias (complications); Female; Fibrinolytic Agents (administration & dosage, therapeutic use); Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Stroke (complications, drug therapy); Thrombolytic Therapy; Tissue Plasminogen Activator (administration & dosage, therapeutic use); Treatment Outcome

Publication Date

1-1-2015

Publication Title

PloS one

E-ISSN

1932-6203

Volume

10

Issue

8

First Page

e0131487

PubMed ID

26247772

Digital Object Identifier (DOI)

10.1371/journal.pone.0131487

Recommended Citation

Dong, Yi; Cao, Wenjie; Ren, Jinma; Nair, Deepak S.; Parker, Sarah; Jahnel, Jan L.; Swanson-Devlin, Teresa G.; Beck, Judith M.; Mathews, Maureen; McNeil, Clayton J.; Upadhyaya, Manas; Gao, Yuan; Dong, Qiang; and Wang, David Z., "Vascular Risk Factors in Patients with Different Subtypes of Ischemic Stroke May Affect Their Outcome after Intravenous tPA" (2015). Neurology. 1830.
https://scholar.barrowneuro.org/neurology/1830