Medicine (RMH) - Research Publications

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Subject: Central Nervous System; Nervous System and Disorders × Author: Meretoja, Atte ×

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    Outcome of ischemic stroke patients with serious post-thrombolysis neurological deficits
    Strbian, D ; Atula, S ; Meretoja, A ; Kaste, M ; Tatlisumak, T (WILEY, 2013-04)
    OBJECTIVES: To identify factors associated with favorable outcome in ischemic stroke patients having considerable post-thrombolytic neurological deficits but without endovascular treatment. MATERIALS AND METHODS: We registered 1427 consecutive thrombolysis-treated ischemic stroke patients, of which 473 (33%) had ≥8 NIH Stroke Scale (NIHSS) points after thrombolysis but did not undergo any further rescue intervention. We dichotomized them based on 3-month modified Rankin Scale (mRS) to those with favorable (mRS 0-2, n = 126, 27%) and unfavorable (mRS 3-6, n = 347) outcome. Univariate and multivariable methods tested associations of baseline and post-thrombolysis parameters with outcome. RESULTS: Lower post-thrombolysis NIHSS score and younger age had strongest association with favorable outcome. Most of patients with post-thrombolytic NIHSS score ≥11 achieved unfavorable outcome. In contrast, half of patients with favorable outcome had post-thrombolytic NIHSS≤10, and 62% of patients younger than 75 years and having post-thrombolytic NIHSS 8-9 achieved favorable outcome. Weaker independent association was observed for blood glucose level and baseline diastolic blood pressure. CONCLUSIONS: As expected, NIHSS score and patient age showed the strongest association with final outcome in a subpopulation of patients having considerable post-thrombolytic neurological deficit. A relatively high proportion of patients with post-thrombolytic NIHSS 8-9 (10) achieved a favorable 3-month outcome without any further intervention.
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    Pre- and in-hospital intersection of stroke care
    Meretoja, A ; Kaste, M ; DelZoppo, GJ ; Alexandrov, AV (BLACKWELL SCIENCE PUBL, 2012)
    Acute ischemic stroke is a time-critical emergency for which thrombolytic therapy is the only medical treatment. Many patients who would benefit from this treatment are deprived of it due to delays. Failure to call for help rapidly is the main obstacle, but even when the call is made in time, the prehospital evaluation, transportation, and emergency department (ED) diagnostics often take too long to treat the patient with thrombolysis. Interventions to reduce pre- and in-hospital delays have been described; although no single intervention is likely to make a major difference, a whole set of interventions needs to be implemented. The intersection of the pre- and in-hospital care is of special importance. With successful protocols and good communication between the emergency medical service and ED, delays can be significantly reduced. On the basis of our experience, 94% of patients can be treated within 60 min of arrival, based largely on using the prehospital time effectively.