Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits
BackgroundAlthough the PRISMS study did not demonstrate the benefit of intravenous alteplase administration in patients with mild stroke within 3 h, about 30% of patients presenting with mild symptoms showed unfavorable functional outcomes. We investigated the factors predictive of functional disabi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.1062721/full |
| _version_ | 1797979308035145728 |
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| author | Yong Jin Kim Seok Hong Choi Tae Young Kim Hyeon-Mi Park Dong Jin Shin Dong Hoon Shin |
| author_facet | Yong Jin Kim Seok Hong Choi Tae Young Kim Hyeon-Mi Park Dong Jin Shin Dong Hoon Shin |
| author_sort | Yong Jin Kim |
| collection | DOAJ |
| description | BackgroundAlthough the PRISMS study did not demonstrate the benefit of intravenous alteplase administration in patients with mild stroke within 3 h, about 30% of patients presenting with mild symptoms showed unfavorable functional outcomes. We investigated the factors predictive of functional disability at 90 days in patients who were excluded from alteplase administration due to the National Institutes of Health Stroke Scale (NIHSS) scores of 0–5 and a score between 0 and 2 for each NIHSS score item.MethodsAll patients were diagnosed with acute ischemic stroke or transient ischemic attack within 4.5 h of admission to a tertiary hospital and did not receive alteplase due to a minor stroke between January 2013 and December 2020. Radiological data and clinical information were collected, including baseline and discharge NIHSS scores and modified Rankin Scale (mRS) scores at 90 days. Early neurological deterioration (END) was defined as an increase of two or more NIHSS scores. We defined moderate motor weakness as a NIHSS limb motor score of more than 3 and defined a favorable outcome as a mRS score at 90 days that was 0 or 1.ResultsDuring the investigation period, 400 patients did not receive alteplase. END occurred significantly more frequently in patients with large artery disease (LAD) than in those with other TOAST classifications. In the multivariate regression analysis, NIHSS per 1-point increase, presenting as moderate motor weakness, and LAD were independent predictors of poor functional outcome (OR, 1.811 NIHSS per 1-point increase; 95% confidence interval [CI], 1.503–2.182; P < 0.0001; OR, 2.173 moderate motor weakness; 95% CI 1.028–4.595; P = 0.042; OR, 2.033 LAD; 95% CI 1.099–3.762; P = 0.024, respectively).ConclusionModerate motor weakness presentation and LAD may be important factors associated with poor functional outcomes in patients with acute stroke excluded from alteplase administration due to mild symptoms. |
| first_indexed | 2024-04-11T05:36:57Z |
| format | Article |
| id | doaj.art-66b747f17f4745809a423c88b0ef969a |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-11T05:36:57Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-66b747f17f4745809a423c88b0ef969a2022-12-22T11:16:50ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-12-011310.3389/fneur.2022.10627211062721Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficitsYong Jin KimSeok Hong ChoiTae Young KimHyeon-Mi ParkDong Jin ShinDong Hoon ShinBackgroundAlthough the PRISMS study did not demonstrate the benefit of intravenous alteplase administration in patients with mild stroke within 3 h, about 30% of patients presenting with mild symptoms showed unfavorable functional outcomes. We investigated the factors predictive of functional disability at 90 days in patients who were excluded from alteplase administration due to the National Institutes of Health Stroke Scale (NIHSS) scores of 0–5 and a score between 0 and 2 for each NIHSS score item.MethodsAll patients were diagnosed with acute ischemic stroke or transient ischemic attack within 4.5 h of admission to a tertiary hospital and did not receive alteplase due to a minor stroke between January 2013 and December 2020. Radiological data and clinical information were collected, including baseline and discharge NIHSS scores and modified Rankin Scale (mRS) scores at 90 days. Early neurological deterioration (END) was defined as an increase of two or more NIHSS scores. We defined moderate motor weakness as a NIHSS limb motor score of more than 3 and defined a favorable outcome as a mRS score at 90 days that was 0 or 1.ResultsDuring the investigation period, 400 patients did not receive alteplase. END occurred significantly more frequently in patients with large artery disease (LAD) than in those with other TOAST classifications. In the multivariate regression analysis, NIHSS per 1-point increase, presenting as moderate motor weakness, and LAD were independent predictors of poor functional outcome (OR, 1.811 NIHSS per 1-point increase; 95% confidence interval [CI], 1.503–2.182; P < 0.0001; OR, 2.173 moderate motor weakness; 95% CI 1.028–4.595; P = 0.042; OR, 2.033 LAD; 95% CI 1.099–3.762; P = 0.024, respectively).ConclusionModerate motor weakness presentation and LAD may be important factors associated with poor functional outcomes in patients with acute stroke excluded from alteplase administration due to mild symptoms.https://www.frontiersin.org/articles/10.3389/fneur.2022.1062721/fullalteplaseacute ischemic strokeminorhyperacute treatmentfunctional outcome after acute stroke |
| spellingShingle | Yong Jin Kim Seok Hong Choi Tae Young Kim Hyeon-Mi Park Dong Jin Shin Dong Hoon Shin Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits Frontiers in Neurology alteplase acute ischemic stroke minor hyperacute treatment functional outcome after acute stroke |
| title | Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits |
| title_full | Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits |
| title_fullStr | Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits |
| title_full_unstemmed | Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits |
| title_short | Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits |
| title_sort | factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non disabling neurological deficits |
| topic | alteplase acute ischemic stroke minor hyperacute treatment functional outcome after acute stroke |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.1062721/full |
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