Endovascular and Thrombolytic Therapy and the Functional Status of Patients after Ischemic Stroke
DOI:
https://doi.org/10.15225/PNN.2019.8.2.4Keywords
stroke, thrombolysis, thrombectomy, functioningAbstract
Introduction. Stroke is treated as a direct threat to life. Mechanical thrombectomy used as an independent treatment or in combination with systemic thrombolysis is currently the standard care in the treatment of ischemic stroke.
Aim. Evaluation of the functional status of patients after ischemic stroke treated with thrombolysis or thrombectomy.
Material and Methods. The study involved 50 patients hospitalized due to ischemic stroke. Standardized research tools were used: the Rankin scale, the Barthel scale and the Functional Index “Repty” (WFR). The study was conducted twice in one patient: on the first and ninth day after the treatment. The collected material was developed statistically.
Results. Most of the respondents were men — 62%. Thrombolytic treatment was used in all subjects, and thrombectomy in 26% people. Analyses showed that there were differences in the Barthel scale level Z = 4.87; p < 0.001, Rankin Z = 4.80; p < 0.001 and WFR Z = 4.83; p < 0.001. The age of the respondents was related negatively to the Barthel scale score on the 1st day = -0.51; p < 0.001 and the 9th day = -0.53; p < 0.001 and the result in the WFR scale on the 1st day = -0.54; p < 0.001 and the 9th day = -0.52; p < 0.001.
Conclusions. The performance of the subjects on the 1st day of treatment was worse than on the 9th day. People who were only treated with thrombolysis had better results in fitness tests and had a lower level of disability than people treated with thrombolysis and thrombectomy. (JNNN 2019;8(2):69–77)
References
Soler E.P., Ruiz V.C. Epidemiology and Risk Factors of Cerebral Ischemia and Ischemic Heart Diseases: Similarities and Differences. Curr Cardiol Rev. 2010;6(3):138–149.
Ganesalingam J., Pizzo E., Morris S., Sunderland T., Ames D., Lobotesis K. Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke. Stroke. 2015;46(9):2591–2598.
Książkiewicz B., Mazur R., Świerkocka-Miastkowska M., Gąsecki D., Serafin Z. Choroby naczyniowe układu nerwowego. W: Mazur R. (Red.), Neurologia kliniczna dla lekarzy i studentów medycyny, Wyd. Via Medica, Gdańsk 2007;170–202.
Wnuk M., Słowik A. Udar mózgu na dyżurze, Wyd. Termedia, Poznań 2016.
Dębińska M., Mraz M. Jakość życia osób po udarze mózgu. Med Rodz. 2016;1(19):14–18.
Kissela B.M., Khoury J.C., Alwell K. et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012;79(17):1781–1787.
Siebert J., Nyka W.M. (Red.), Udar mózgu. Postępowanie diagnostyczne i terapia w ostrym okresie udaru, Wyd. Via Medica, Gdańsk 2006.
Balami J.S., Hadley G., Sutherland B.A., Karbalai H., Buchan A.M. The exact science of stroke thrombolysis and the quiet art of patient selection. Brain. 2013;136(Pt 12):3528–3553.
Bhaskar S., Stanwell P., Cordato D., Attia J., Levi C. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurol. 2018;18(1):8.
Wechsler L.R. Intravenous thrombolytic therapy for acute ischemic stroke. N Engl J Med. 2011;364(22):2138–2146.
Fanous A.A., Siddiqui A.H. Mechanical thrombectomy: Stent retrievers vs. aspiration catheters. Cor et Vasa. 2016;58(2):e193–e203.
Kobayashi A., Czepiel W. Wewnątrznaczyniowe metody leczenia udaru niedokrwiennego mózgu. Pol Przegl Neurolog. 2008;4(Suppl A):18–19.
van Swieten J.C., Koudstaal P.J., Visser M.C., Schouten H.J., van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–607.
Mahoney F.I., Barthel D.W. Functional evaluation: The Barthel Index. Md State Med J. 1965;14:61–65.
Opara J. Analiza przydatności wybranych skal udarów do oceny wyników rehabilitacji chorych z niedowładem połowiczym. Rozprawa habilitacyjna, Śląska Akademia Medyczna, Katowice 1996.
Lichtman J.H., Watanabe E., Allen N.B., Jones S.B., Dostal J., Goldstein L.B. Hospital arrival time and intravenous t-PA use in US Academic Medical Centers, 2001–2004. Stroke. 2009;40(12):3845–3850.
Lin M.P., Sanossian N., Liebeskind D.S. Imaging of prehospital stroke therapeutics. Expert Rev Cardiovasc Ther. 2015;13(9):1001–1015.
Nogueira R.G., Jadhav A.P., Haussen D.C. et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378(1):11–21.
Hacke W. A New DAWN for Imaging-Based Selection in the Treatment of Acute Stroke. N Engl J Med. 2018;378(1):81–83.
Zafar A., Al-Khamis F.A., Al-Bakr A.I., Alsulaiman A.A., Msmar A.H. Risk factors and subtypes of acute ischemic stroke. A study at King Fahd Hospital of the University. Neurosciences (Riyadh). 2016;21(3):246–251.
Soliman R.H., Oraby M.I., Fathy M., Essam A.M. Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):8.
Goff D.C. Jr, Lloyd-Jones D.M., Bennett G. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–2959.
Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015;3(5):418–429.
Kleinrok A., Płaczkiewicz D., Stefańczyk P., Kudrelek K. Wpływ wybranych czynników socjodemograficznych i klinicznych na stopień niepełnosprawności pacjentów hospitalizowanych z powodu udaru mózgu. Prz Med Uniw Rzesz Inst Leków. 2013;2:151–163.
Kalaria R.N. Cerebrovascular disease and mechanisms of cognitive impairment: evidence from clinicopathological studies in humans. Stroke. 2012;43(9):2526–2534.
Pawłowska K. Problemy zdrowotne chorych po udarze mózgu zmuszonych do ponownego korzystania z pomocy szpitalnej. Piel Op Długotermin. 2018;4:23–31.
Osemene N.I. The Neurologic Complications of Ischemic Stroke. US Pharm. 2013;38(1):HS1–HS5.
Barrett A.M., Muzaffar T. Spatial cognitive rehabilitation and motor recovery after stroke. Curr Opin Neurol. 2014;27(6):653–658.
Grochulska A., Jastrzębska M. Poprawa stanu funkcjonalnego osób po przebytym udarze mózgu — rola pielęgniarki. Probl Pielęg. 2012;20(3):300–309.
Van Hooff R.J., Nieboer K., De Smedt A. et al. Validation assessment of risk tools to predict outcome after thrombolytic therapy for acute ischemic stroke. Clin Neurol Neurosurg. 2014;125:189–193.
Sarraj A., Albright K., Barreto A.D. et al. Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke. Stroke. 2013;44(12):3324–3330.
Shuaib A., Schwab S., Rutledge J.N. et al. Importance of proper patient selection and endpoint selection in evaluation of new therapies in acute stroke: further analysis of the SENTIS trial. J Neurointerv Surg. 2013;5(Suppl 1):i21–24.
de Andrés-Nogales F., Álvarez M., de Miquel M.Á. et al. Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain. Eur Stroke J. 2017;2(3):272–284.
Rosińczuk J., Bonk K., Kołtuniuk A. Analysis of thrombolytic therapy in ischemic stroke treatment. Ann Acad Med Siles. 2015;69:125–131.
Evans M.R.B., White P., Cowley P., Werring D.J. Revolution in acute ischaemic stroke care: a practical guide to mechanical thrombectomy. Pract Neurol. 2017;17(4):252–265.
Emberson J., Lees K.R., Lyden P. et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929–1935.
Kobayashi A., Niewada M., Członkowska A., Ryglewicz D., Trojanowski T., Fiszer U. Trombektomia w udarze niedokrwiennym mózgu — stanowisko Komitetu Nauk Neurologicznych Polskiej Akademii Nauk. Nauka. 2016;3:161–168.
Goyal M., Menon B.K., van Zwam W.H. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–1731.
Rodrigues F.B., Neves J.B., Caldeira D., Ferro J.M., Ferreira J.J., Costa J. Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis. BMJ. 2016;353:i1754.
Lin C., Li N., Wang K. et al. Efficacy and safety of endovascular treatment versus intravenous thrombolysis for acute ischemic stroke: a meta-analysis of randomized controlled trials. PLoS One. 2013;8(10):e77849.
Singh B., Parsaik A.K., Prokop L.J., Mittal M.K. Endovascular therapy for acute ischemic stroke: a systematic review and meta-analysis. Mayo Clin Proc. 2013;88(10):1056–1065.
Fargen K.M., Neal D., Fiorella D.J., Turk A.S., Froehler M., Mocco J. A meta-analysis of prospective randomized controlled trials evaluating endovascular therapies for acute ischemic stroke. J Neurointerv Surg. 2015;7(2):84–89.
Osanai T., Pasupuleti V., Deshpande A. et al. Acute endovascular reperfusion therapy in ischemic stroke: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2015;10(4):e0122806.
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