Abstract Details

Title Immediate Response To Intravenous Recombinant Alteplase In Different Stroke Types

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-017

Objective We evaluated the immediate response to intravenous-recombinant-alteplase (IV-rtPA) in different stroke subtypes.

Background Ischemic stroke subtypes have different pathophysiological mechanisms and have a different composition of clots.

Design/Methods We performed a retrospective chart review of patients evaluated for acute strokes from 7/2014 to 3/2018 at University Hospital. Patients included in the study were given IV-rtPA and had NIHSS scores documented at the presentation and intervals of 1-hour and 24-hours post-IV-rtPA. Patients who underwent mechanical thrombectomy were excluded. Strokes were classified according to the TOAST criteria. Stroke subtypes were considered as categorical variables, with NIHSS scores as continuous variables. A Wilcoxon signed-rank test was used to compare variables. The primary outcome was an improvement in NIHSS score at 1-hour and 24-hours post-IV-rtPA.

Results 63 patients met the inclusion criteria. Compared to the presentation, there was a statistically significant difference in NIHSS scores 1-hour post administration of IV-rtPA in stroke the subgroups of large vessel disease (LVD) (95% CI, 2.00-8.50; P 0.017), cardioembolic (CE) (95% CI, 2.00-6.50; P 0.006) and undetermined etiology (UE) (95% CI, 2.50-7.00; P 0.001), but not in the subgroup of small vessel disease (SVD) (90% CI, -5.00-4.00; P 0.786). Similarly, compared to the presentation, there was a statistically significant difference in NIHSS scores 24-hours post administration of IV-rtPA in stroke subgroups of LVD (95% CI, 2.50-9.50; P 0.017), CE (95% CI, 1.00-4.50; P 0.007) and UE (95% CI, 1.00-5.00; P 0.003), but not in subgroup of SVD (95% CI, -5.00-5.00; P 0.344).

Conclusions All stroke subtypes, except for SVD subtype, showed a significant improvement in NIHSS score at 1-hour and 24-hours post-IV-rtPA. Lack of significant immediate response to IV-tPA in SVD strokes may be due to a different underlying pathophysiological mechanism of lacunar strokes. The immediate response to IV-rtPA in the SVD subtype is potentially uncertain, according to this study.

Authors/Disclosures
Taha Nisar, MD (Rutgers New Jersey Medical School) PRESENTER	Dr. Nisar has nothing to disclose.

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Abstract Details